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MPU3313

Health and Wellness 2

Copyright © Open University Malaysia (OUM)


MPU3313
HEALTH AND
WELLNESS 2
Prof Dr Sha’ari Abd. Hamid
Assoc Prof Raijah Rahim
Rames Prasath Mahatam Rai
Rosnida Abu Bakar
Noor Asiah Md Noor

Copyright © Open University Malaysia (OUM)


Project Director: Prof Dato’ Dr Mansor Fadzil
Open University Malaysia

Module Writers: Prof Dr Sha’ari Abd. Hamid


Assoc Prof Raijah Rahim
Rames Prasath Mahatam Rai
Rosnida Abu Bakar
Noor Asiah Md Noor
Open University Malaysia

Moderator: Prof Dr Faridah Hashim


Open University Malaysia

Developed by: Centre for Instructional Design and Technology


Open University Malaysia

First Edition, August 2016


Second Edition, December 2017
Copyright © Open University Malaysia (OUM), December 2017, MPU3313
All rights reserved. No part of this work may be reproduced in any form or by any means
without the written permission of the President, Open University Malaysia (OUM).

Copyright © Open University Malaysia (OUM)


Table of Contents
Course Guide ixăxiv

Topic 1 Concept of Health and Wellness 1


1.1 Meaning of Health 3
1.2 Meaning of Wellness 4
1.3 Characteristics of a Healthy Lifestyle 6
1.3.1 Personal Responsibility for Health and Wellness 8
1.4 Influences on Health and Wellness 12
1.4.1 Predisposing Factors 12
1.4.2 Reinforcing Factors 14
1.4.3 Barriers to Wellness 15
1.4.4 Lifestyle Influences 16
1.5 Benefits of a Comprehensive Health and Wellness Lifestyle 17
1.5.1 Improved Cardiovascular or Heart and Blood 18
Vessels Efficiency
1.5.2 Increased Muscle Tone, Strength, Flexibility and 18
Endurance
1.5.3 Improved Self-control, Self-efficacy and Self-esteem 19
1.5.4 Improved Stress Management and Outlook in Life 19
1.5.5 Improved Interpersonal Relationships 19
1.5.6 Decreased Mortality and Morbidity from Illnesses 20
1.6 Conclusion 20
Summary 22
Key Terms 23
References 23

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iv  TABLE OF CONTENTS

Topic 2 Dimensions of Health and Wellness I 24


2.1 Dimensions of Health and Wellness 25
2.2 Physical Dimension 28
2.2.1 What is Physical Fitness? 30
2.2.2 Developing a Cardiorespiratory Fitness Programme 31
2.3 Emotional Dimension 33
2.3.1 Emotional Stability 34
2.3.2 Self-concept 35
2.4 Spiritual Dimension 37
2.5 Intellectual Dimension 39
Summary 41
Key Terms 42
References 43

Topic 3 Dimensions of Health and Wellness II 44


3.1 Social Dimension 45
3.2 Occupational Dimension 50
3.3 Environmental Dimension 54
3.4 Financial Dimension 58
3.4.1 The Impetus that Led to the Creation of a Financial 59
Wellness Programme
3.4.2 Financial Wellness at the Workplace 60
Summary 61
Key Terms 61
References 62

Topic 4 Understanding Nutrition and Diet 63


4.1 Components of Healthy Diet 65
4.1.1 Proteins 66
4.1.2 Carbohydrates 67
4.1.3 Fats 69
4.1.4 Vitamins 71
4.1.5 Minerals 74
4.1.6 Water 74
4.1.7 Dietary Challenges for Special Groups 75
4.2 Healthy versus Therapeutic Diet 77
4.2.1 Healthy Diet 77
4.2.2 Therapeutic Diet 80
Summary 84
Key Terms 85
References 85

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TABLE OF CONTENTS  v

Topic 5 Maintaining Weight 87


5.1 Basic Concepts of Weight Management 88
5.1.1 Body Mass Index (BMI) 88
5.1.2 Body Composition 90
5.2 Obesity 92
5.3 Eating Disorders 95
5.3.1 Anorexia Nervosa 96
5.3.2 Bulimia Nervosa 98
5.4 Weight Management Techniques 99
Summary 102
Key Terms 103
References 104

Topic 6 Preventing Diseases 105


6.1 Importance of Disease Prevention 106
6.2 Cardiovascular Diseases 108
6.2.1 Understanding the Heart 108
6.2.2 Risk Factors that Cause Coronary Heart Disease 110
(CHD)
6.2.3 Seriousness of Coronary Heart Disease 110
6.2.4 Signs and Symptoms of Coronary Heart Disease 111
6.2.5 Preventing Coronary Heart Disease 112
6.3 Understanding Cancer 113
6.3.1 What is Cancer? 113
6.3.2 Common Types of Cancer 115
6.3.3 Risk Factors for Cancer 115
6.3.4 Signs and Symptoms of Cancer 116
6.3.5 Prevention Strategies for Cancer 116
6.4 Understanding Diabetes Mellitus 118
6.4.1 Causes of Diabetes Mellitus 118
6.4.2 Classification of Diabetes Mellitus 120
6.4.3 Risk Factors of Diabetes Mellitus 120
6.4.4 Prevention of Diabetes Mellitus 121
6.5 Osteoporosis 122
6.5.1 Risk Factors for Osteoporosis 122
6.5.2 Prevention Strategies for Osteoporosis 123

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vi  TABLE OF CONTENTS

6.6 Kidney Disease 124


6.6.1 Common Causes of Kidney Disease 125
6.6.2 Signs and Symptoms of Kidney Disease 126
6.6.3 Risk Factors for Kidney Disease 126
6.6.4 Prevention of Kidney Disease 127
Summary 131
Key Terms 133
References 134

Topic 7 Financial Health and Wellness 135


7.1 Financial Health and Wellness 136
7.1.1 Importance of Financial Wellness in the Context of 138
OneÊs Total Health
7.2 Challenges to Financial Wellness 141
7.2.1 Economic Challenges 142
7.2.2 Other Challenges 142
7.2.3 Contributing Factors to Delayed Adulthood 144
7.3 Elements of Financial Wellness 149
7.4 Financial Fitness 153
Summary 156
Key Terms 157
References 158

Topic 8 Medical and Health Insurance 161


8.1 What is Insurance? 162
8.2 Fundamentals of Insurance 163
8.3 Life Insurance 165
8.3.1 What is Life Insurance? 165
8.3.2 Types of Life Insurance Policies 166
8.4 Medical and Health Insurance 167
8.4.1 Types of Medical and Health Insurance (MHI) 168
Policies
8.4.2 MHI Policy Benefits 169
8.4.3 Policy Renewal 170
8.4.4 Policy Cancellation 170
8.4.5 Exceptions 170
8.4.6 Making a Claim 171
Summary 172
Key Terms 172
References 173

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Copyright © Open University Malaysia (OUM)
Copyright © Open University Malaysia (OUM)
COURSE GUIDE  ix

COURSE GUIDE DESCRIPTION


You must read this Course Guide carefully from the beginning to the end. It tells
you briefly what the course is about and how you can work your way through
the course material. It also suggests the amount of time you are likely to spend in
order to complete the course successfully. Please keep on referring to the Course
Guide as you go through the course material as it will help you to clarify
important study components or points that you might miss or overlook.

INTRODUCTION
MPU3313 Health and Wellness 2 is one of the courses offered by Open
University Malaysia (OUM). This course is worth 3 credit hours course and
should covered over 8 to 15 weeks.

COURSE AUDIENCE
This course is a compulsory course for all learners of OUM.

As an open and distance learner, you should be acquainted with learning


independently and being able to optimise the learning modes and environment
available to you. Before you begin this course, please ensure that you have the
right course material, and understand the course requirements as well as how the
course is conducted.

STUDY SCHEDULE
It is a standard OUM practice that learners accumulate 40 study hours for every
credit hour. As such, for a three-credit hour course, you are expected to spend
120 study hours. Table 1 gives an estimation of how the 120 study hours could be
accumulated.

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x  COURSE GUIDE

Table 1: Estimation of Time Accumulation of Study Hours

Study
Study Activities
Hours
Briefly go through the course content and participate in initial discussions 3
Study the module 60
Attend 3 to 5 tutorial sessions 10
Online participation 12
Revision 15
Assignment(s), Test(s) and Examination(s) 20
TOTAL STUDY HOURS ACCUMULATED 120

COURSE OUTCOMES
By the end of this course, you should be able to:

1. Explain the concept of health and wellness;


2. Discuss the eight dimensions of health and wellness;
3. Plan diet according to nutritional needs;
4. Select strategies to prevent common diseases;
5. Summarise what is meant by the term financial wellness; and

6. Discuss types of life insurance including medical and health.

COURSE SYNOPSIS
This course is divided into eight topics. The synopsis for each topic can be listed
as follows:

Topic 1 introduces the learners to the basic concept of health and wellness,
characteristics of a healthy lifestyle and personal responsibility to maintain
health and wellness. As a learner, you will have the opportunity to plan for
personal health and wellness improvement based on individual scores for the
healthy lifestyle.

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COURSE GUIDE  xi

Topic 2 focuses on the first four dimensions of health and wellness; physical,
emotional, spiritual and intellectual. In this topic, learners will be exposed to
examples of physical activities that contribute to physical wellness. Hopefully,
the lesson will help learners to plan the strategies for emotional wellness, achieve
spiritual support as well as recognise the importance of intellectual dimension in
health and wellness.

Topic 3 concentrates on the other four dimensions of health and wellness which
are social, occupational, environmental and financial. It also explains some
strategies to enhance social wellness. It is hoped that you can identify the factors
that contribute to occupational wellness as well as your personal responsibility to
promote environmental awareness. Last but not least, basic understanding on
personal management of financial matters is also available in this topic.

Topic 4 highlights the component of healthy diet as well as dietary requirement


for special groups of people. This topic also discusses the challenges faced by the
special groups of people in complying with therapeutic diet. Hopefully by
learning this topic, you will be able to plan a diet based on your personal
requirement.

Topic 5 discusses the concept of weight management related to body mass index
(BMI). You will be able to relate obesity, anorexia nervosa and bulimia as a
consequence of eating disorders. It is hoped that by the end of this topic, you will
be able to suggest techniques for ideal weight management.

Topic 6 highlights the importance of disease prevention to promote health and


wellness. Then, there is a discussion on common non-communicable diseases
that are linked to life style choices. Hopefully by going through this topic, you
will be able to apply the knowledge to suggest preventive approaches for
coronary heart disease, cancer, diabetes mellitus, osteoporosis and kidney
disease. In addition, you will be able to design your own personal plan to
improve your health and wellness based on appraisal of risk for diabetes and
osteoporosis.

Topic 7 focuses on financial health and wellness. This topic begins with a
discussion on financial health and financial wellness, followed by the challenges
confronting young adults in their quest for financial wellness. Then, you will be
introduced to the elements of financial wellness. Lastly, you will learn about
financial fitness. Hopefully by the end of this topic, you will be able to construct
your own financial fitness plan based on the knowledge given in this topic as
well as other topics.

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xii  COURSE GUIDE

Topic 8 focuses on medical and health insurance. This topic will provide learners
some guidelines related to insurance and essential elements in purchasing
insurance by individuals or organisation.

TEXT ARRANGEMENT GUIDE


Before you go through this module, it is important that you note the text
arrangement. Understanding the text arrangement will help you to organise your
study of this course in a more objective and effective way. Generally, the text
arrangement for each topic is as follows:

Learning Outcomes: This section refers to what you should achieve after you
have completely covered a topic. As you go through each topic, you should
frequently refer to these learning outcomes. By doing this, you can continuously
gauge your understanding of the topic.

Self-Check: This component of the module is inserted at strategic locations


throughout the module. It may be inserted after one sub-section or a few sub-
sections. It usually comes in the form of a question. When you come across this
component, try to reflect on what you have already learnt thus far. By attempting
to answer the question, you should be able to gauge how well you have
understood the sub-section(s). Most of the time, the answers to the questions can
be found directly from the module itself.

Activity: Like Self-Check, the Activity component is also placed at various


locations or junctures throughout the module. This component may require you to
solve questions, explore short case studies, or conduct an observation or research.
It may even require you to evaluate a given scenario. When you come across an
Activity, you should try to reflect on what you have gathered from the module and
apply it to real situations. You should, at the same time, engage yourself in higher
order thinking where you might be required to analyse, synthesise and evaluate
instead of only having to recall and define.

Summary: You will find this component at the end of each topic. This component
helps you to recap the whole topic. By going through the summary, you should
be able to gauge your knowledge retention level. Should you find points in the
summary that you do not fully understand, it would be a good idea for you to
revisit the details in the module.

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COURSE GUIDE  xiii

Key Terms: This component can be found at the end of each topic. You should go
through this component to remind yourself of important terms or jargon used
throughout the module. Should you find terms here that you are not able to
explain, you should look for the terms in the module.

References: The References section is where a list of relevant and useful


textbooks, journals, articles, electronic contents or sources can be found. The list
can appear in a few locations such as in the Course Guide (at the References
section), at the end of every topic or at the back of the module. You are
encouraged to read or refer to the suggested sources to obtain the additional
information needed and to enhance your overall understanding of the course.

PRIOR KNOWLEDGE
No prior knowledge required.

ASSESSMENT METHOD
Please refer to myINSPIRE.

REFERENCES
Donatelle, R., Snow, C., & Wilcox, A. (1999). Wellness: Choices for health and
fitness (2nd ed.). Belmont, CA: Wadsworth.

Edlin, G., & Golanty, E. (2010). Health and wellness (10th ed.). Sudbury, MA:
Jones & Bartlett.

Hoeger, W. K., & Hoeger S. S. (2003). Lifetime physical fitness and wellness:
A personalized program (7th ed). Belmont, CA: Thomson Wadsworth.

Insel, P. M., & Roth, W. T. (2008). Core concepts in health (10th ed.). Boston, MA:
McGraw-Hill.

Ismawati, S., Zainalabidin, M., & Golnaz, R. (2014). Healthy eating: The
preventive factors among Malaysians. Journal of Economics, Business and
Management, 2(4), 257-261.

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xiv  COURSE GUIDE

National Coordinating Committee on Food and Nutrition, Ministry of Health


Malaysia. (2010). Malaysian dietary guidelines. Retrieved from
http://dg.cnsoc.org/upload/affix/20140818104029708.pdf

Payne, W. A., Hahn D. B., & Mauer, E. B. (2005). Understanding your health (8th
ed). Boston, MA: McGraw-Hill.

Pruss-Ustun, A., & Corvalan, C. (2006). Preventing disease through health


environment: Towards an estimate of the environmental burden of disease.
Geneva, Switzerland: WHO Press.

Whitney, E. N., & Rolfes, S. R. (2002). Understanding nutrition (9th ed.). Victoria,
Australia: Wadsworth Thomson Learning.

Williams, M. H., Anderson, D. E., & Rawson, E. S. (2013). Nutrition for health,
fitness and sport (10th ed.). New York, NY: McGraw-Hill.

TAN SRI DR ABDULLAH SANUSI (TSDAS) DIGITAL


LIBRARY
The TSDAS Digital Library has a wide range of print and online resources for the
use of its learners. This comprehensive digital library, which is accessible
through the OUM portal, provides access to more than 30 online databases
comprising e-journals, e-theses, e-books and more. Examples of databases
available are EBSCOhost, ProQuest, SpringerLink, Books24x7, InfoSci Books,
Emerald Management Plus and Ebrary Electronic Books. As an OUM learner,
you are encouraged to make full use of the resources available through this
library.

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Topic  Concept of
1 Health and
Wellness
LEARNING OUTCOMES
By the end of this topic, you should be able to:
1. Differentiate between health and wellness;
2. Describe the characteristics of a healthy lifestyle;
3. Identify the personal responsibilities for attaining and maintaining
health and wellness in an individual;
4. Identify factors which characterise the health and wellness state of an
individual; and
5. Summarise the benefits of a comprehensive health and wellness
lifestyle.

 INTRODUCTION
Let us begin our learning of this module by first considering a concept which
may be familiar to you.

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2  TOPIC 1 CONCEPT OF HEALTH AND WELLNESS

Figure 1.1: A common wish during birthdays

How do you feel when someone conveys an affectionate greeting such as


illustrated in Figure 1.1 above? What type of message and feelings are expressed
when we greet a person? I am sure you would agree that the message implies
wishes for good health, abundance of wealth and happiness. Such greetings
establish a sense of pleasantness and enhance social interactions especially on
joyous occasions such as holidays, birthdays, weddings and other celebratory
events. The pleasantries conveyed through greetings transcend gender, economic
status, race, religion, culture, as well as age. Reflect about the times when you
personally greeted someone who mattered and likewise, you must have felt good
when the good wishes were returned. Expressions consciously or unconsciously
represent a value we attach to being happy, healthy and prosperous for ourselves
as well as those who are dear to us.

Considering that, the expressed intention of greetings is mainly to convey


goodness in an affectionate manner, the wishes acknowledge that a multitude of
elements are important for a true sense of contentment and well-being in life. The
contents of well wishes combine at least three elements ă in this case, happiness,
healthiness and prosperity, to be bestowed upon its recipients. The context of a
greeting conveys a wish for a delightful state of mind manifested in the form of a
psychological feeling of joy, freedom from physical infirmity, and an
accumulation of material wealth to signify prosperity.

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TOPIC 1 CONCEPT OF HEALTH AND WELLNESS  3

An important inference one can draw from the foregoing discussion is that the
well-being of a person is dependent on a combination of factors. Hence,
happiness, healthiness and prosperity are collectively desirable elements for a
sense of well-being. It is difficult to be happy if one is not healthy. Likewise, one
may not be able to relish his/her prosperity if one is not happy or healthy
enough to enjoy it.

In the following subtopics, you will acquire further clarity on the concepts of
health and wellness as being vital components of well-being. In addition, the
contents of the subtopic will also cover characteristics of a healthy lifestyle,
personal responsibilities for attaining and maintaining health and wellness,
factors that characterise the health and wellness state of an individual and the
benefits of a comprehensive health and wellness lifestyle. We hope that you will
enjoy this first topic and gain a lot of knowledge on health and wellness. Let us
delve deeper into the lesson!

1.1 MEANING OF HEALTH


Let us first look at the meaning of health. Later in the next subtopic, we will look
at the concept of wellness. Hopefully, by the end of these two subtopics, you will
be able to differentiate between health and wellness.

How would you define health? As you may be well aware, there are people who
may not have an actual idea about what „health‰ means, though each may
express it in his/her own unique way. Some however understand what „health‰
means but are unable to express the concept clearly. Let us look at a formal
definition of health by the World Health Organization (WHO).

„Health‰ can be defined as the state of complete physical health, mental


health and social well-being, and not merely the absence of illness and
infirmity.
WHO (2003)

As you can infer from the definition by WHO, being healthy encompasses a wide
span of factors and is not just about being free from diseases.

Since the established definition by WHO, there have been additional


explanations to help further clarify health as a concept within several
dimensions. Currently, many people describe health as being a multi-
dimensional concept encompassing different aspects of personal life. For
example, Donatelle, Snow and Wilcox (1999) consider the concept of health as
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4  TOPIC 1 CONCEPT OF HEALTH AND WELLNESS

being a vigorous balance between the social, physical, psychological, intellectual,


environmental and spiritual dimensions of a person.

Today, health is regarded as a dynamic and ever-changing concept that is very


much dependant on personal choices. This implies that a person can influence his
or her health either positively or negatively, through life-style preferences.
Conversely, there are people today who experience an on-going struggle
between choosing to indulge in negative habits or maintaining a healthy lifestyle.
These components of health will be described further in the subsequent
subtopics.

ACTIVITY 1.1

1. Based on the definition of „health‰ by WHO (2003), identify the


status of each of the following characteristics of health in your
own personal life:
(a) Physical health;
(b) Mental health; and
(c) Social well-being.

2. Cite any major differences between the WHO definition and other
explanations of health.

1.2 MEANING OF WELLNESS


Now let us continue our lesson by focusing on wellness. Over the years, new
discoveries and technological innovations have improved literacy and
understanding of the significant value of preventive and promotive aspects of
healthcare preservation.

Consequently, expectations are growing from merely being healthy to aspirations


for a higher quality of life. People no longer accept that being healthy and
disease-free means subscribing to a „pill-popping‰ culture. Rather, they wish to
be stronger and fitter and strive in sports and recreational physical activities to be
reassured of their superior wellness state.

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TOPIC 1 CONCEPT OF HEALTH AND WELLNESS  5

Historically, the concept of „wellness‰ was first introduced in the early 1970s to
represent individual attempts at perking up the existing state of health. Dunn
(1977) first used the word „wellnessÊ to signify an active process in which a
person becomes aware of and makes conscious personal choices to achieve a
healthier state of being in all important dimensions of his or her life.

Edlin and Golanty (2010) further summed up the concept of wellness as being a
proactive and preventive approach designed to achieve optimum levels of
physical health, as well as social and emotional functioning. It can be seen as a
commitment within personal limitations and potentials and a process of
continued striving towards optimal health, without merely focusing on the
absence of diseases.

From the previous explanations, it is hoped that you have noticed the subtle
differences between „wellness‰ and „health‰. To summarise, health is a state of
well-being at a particular moment based on the ability of an individual to
perform basic activities of daily living. Wellness on the other hand, is an active
process through which a person becomes aware of personal limitations and
makes conscious choices to gain more independence from the constraints to his
or her contentment for a successful existence.

Are you ready for the next subtopic? We will explore the significant
characteristics that reflect a health and wellness lifestyle in the following
subtopic.

SELF-CHECK 1.1

Differentiate between health and wellness.

ACTIVITY 1.2

Reflect on your own state of health and answer the following questions:

(a) What are some of your concerns regarding personal health issues?

(b) Write down some examples of activities you may wish to do to


improve your personal wellness.

(c) Compare your answers to the above questions with those of your
course mates.

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6  TOPIC 1 CONCEPT OF HEALTH AND WELLNESS

1.3 CHARACTERISTICS OF A HEALTHY


LIFESTYLE
After reading this subtopic, I hope that you will be able to describe the
characteristics of a healthy lifestyle.

Now that you have a basic understanding about the concepts of health and
wellness, let us deliberate on the characteristics of a healthy individual. Before
we proceed, do ponder about the kind of life you live now and what
improvements you wish for yourself in the future. Chances are that you will opt
for being well, having an abundance of energy for your daily activities and being
free to pursue your dreams for as long as GodÊs given lifespan permits.

Why do we need to choose a healthy lifestyle? A healthy lifestyle offers a choice


of living behaviours which maximise the state of wellness and decrease risk of
illness and premature death.

Choices for leading a healthy lifestyle can be influenced by a multitude of


personal factors as well as external influences. Examples of personal factors
range from internal to external motivation, personal values, ethics and cultural
influences, religious beliefs and fear of life-threatening diseases. On the other
hand, external influences that affect lifestyle choices include environmental,
political and socioeconomic factors. The characteristics of a healthy lifestyle will
be determined by the effects of the choices a person makes in response to
personal habits and the external influences that will shape his or her health
status.

What can a person do to adopt a healthy lifestyle? The immediate choice may be
driven by the degree of internal or external locus of control within the person for
the desire to change. A person with strong internal locus of control will be
inspired by a personal wish to adopt a healthy lifestyle, regardless of how strong
the obstacles are. A person with a strong sense of external locus of control, on the
other hand, would want to survey the worth of external rewards or approval
from external sources as a reason to commit to change.

Sometimes the external source of persuasion to act may seem trivial or intangible
such as idealistic thinking of wellness after seeing a model that we admire or a
chance reading of an article on health and wellness strategies. At other times, the
desire could be more resolute such as making a strong commitment to change
dietary practices after a disheartening observation of body weight on the
weighing scale. Whatever the motives, closing the gap between aspiration and
accomplishment requires a firm commitment that is executed gradually in a
consistent manner towards desired goals.
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TOPIC 1 CONCEPT OF HEALTH AND WELLNESS  7

Humans are very much influenced by social factors. Many of our motives and
compulsions are driven by external influences. We all wish to look and feel good
especially within our social circles. It is a common human trait to be acutely
conscious about body image. But a person who has invested time and effort to
maintain a high degree of wellness will project self-confidence and will not easily
be distraught by the negative opinions of others.

The nature of relationship a person forges with other people as well as


appreciation and tolerance for diversity are also important factors for enhancing
the state of wellness. Light hearted humour and open-mindedness help to block
out negativity and promote positive thoughts in an individual. These wellness
behaviours contribute to the development of a positive awareness which can
reduce stress and have significant influence on the health and wellness of a person.

Based on the above discussion, we can see that lifestyle choices can be influenced
by numerous circumstances, ranging from personal factors to external influences.
Whatever the nature of influence, ultimately, it is up to the individual to act.

The following are some guidelines that characterise healthy lifestyle choices:

(a) Eating a well-balanced and nourishing diet;


(b) Maintaining a healthy body weight;
(c) Regular exercising;
(d) Able to control stress;
(e) Able to manage extreme emotions;
(f) Adequate rest and sleep;
(g) Maintaining a healthy balance between work and social activities;
(h) Engaging in spiritual nourishment or worship according to oneÊs faith;
(i) Avoidance of smoking, alcohol and abuse of recreational drugs;
(j) Regular health screening for early detection of health threats;
(k) Prioritising personal safety;
(l) Making an effort for continuous self-improvement;
(m) Maintaining an optimistic and positive outlook at life; and
(n) Being an active advocate for a healthy environment.

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8  TOPIC 1 CONCEPT OF HEALTH AND WELLNESS

ACTIVITY 1.3

Reflect on your current state of health and work on the following:

(a) List down as many factors as possible that have influenced your
current health status.

(b) Draw up a personal „wish-list‰ that would significantly improve


your current state of health.

1.3.1 Personal Responsibility for Health and Wellness


Let us continue our lesson. It is hoped that by going through this subtopic, you
will be able to identify the personal responsibilities for attaining and maintaining
health and wellness in an individual.

A utilitarian perspective of health and wellness will subscribe to the assumption


that people should take personal responsibility to enhance their quality of life.
Alternatively, giving in to adverse sentiments such as negative thoughts,
procrastination and feelings of „self-pity‰ will only depreciate the state of wellness.

In the next subtopic, we will examine some of the attributes which impact an
individualÊs personal responsibility for health and wellness. What are they? Let
us look at Figure 1.2 for the answers.

Figure 1.2: Three attributes of personal responsibilities for attaining


and maintaining health and wellness in an individual

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TOPIC 1 CONCEPT OF HEALTH AND WELLNESS  9

Now let us look at these three attributes further.

(a) Personal Responsibility for Action


Individuals who strive to maintain optimum health are often able to
differentiate between modifiable risk factors and non-modifiable risk
factors that have an influence over their health status. What do these factors
refer to? Let us look at Table 1.1 for the answers.

Table 1.1: Modifiable Risk Factors versus Non-modifiable Risk Factors

Modifiable Risk Factors Non-modifiable Risk Factors

Refers to factors within the control of an Refers to factors that are not within the
individual, whereby he or she can take control of an individual, such as increased
action to reduce or prevent the risks of vulnerability to certain diseases due to
adverse events from occurring, such as gender or as a result of advancing age.
choosing to refrain from smoking.

Realisation of modifiable and non-modifiable risk factors will help people


to adjust their physical activities to suit their personal capabilities and
limitations when making conscious choices to improve their wellness state.
With the right information, they can make strong personal commitments to
modify their lifestyles and avert negative behaviours that will impede their
quest for optimal health.

There are several guidelines to enhance modifiable behavioural patterns


such as:

(i) Engaging in regular and effective physical exercises;


(ii) Not smoking or indulging in recreational drugs or alcohol;
(iii) Eating wholesome nutritious meals;
(iv) Striking a healthy balance between work, personal, family and social
life;
(v) Shunning excessive stressors; and
(vi) Advocacy for health-orientated policies and programmes within the
family and community.

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10  TOPIC 1 CONCEPT OF HEALTH AND WELLNESS

(b) Concern for Others


Societal elements have a strong potential to influence the health and
wellness choices of a person. People-centred individuals tend to enjoy a
greater sense of wellness compared to social recluses. The former readily
exude an aura of social connectedness and possess a tendency to be more
comfortable in adapting to changing situations while remaining committed
to their wellness goals. This group of people also seem to be good role
models for others who may wish to participate in wellness orientated
activities but are shy to do so.

Good individuals show a caring attitude through words and actions that
reflect their respect and concern for others around them. In addition, they
tend to be un-critical and do not impose their own values by being
judgmental towards others. They are more likely to be socially aware of
variants in health issues among other people around them and act in a
socially responsible manner to fit in with like-minded individuals with
similar goals.

(c) Health Awareness and Sound Decision-making


Although it is said that psychology has influence over physiology,
achieving a high degree of wellness does not happen overnight by just
wishing or being positive about it. Some people who are in a hurry to get
fit, look for „shortcuts‰ through the means of commercial „fast-track‰
formulas that are being peddled in the market. Disillusionment however
sets in after awhile once the promised hype fades and they realise the truth
about the „no pain, no gain‰ maxim to reap benefits from exercise and
physical fitness.

An individual who manages to sustain a wellness state over a period of


time is a person who consciously chooses to set aside dedicated time and
energy for wellness enabling activities that are well within his or her means
of achieving.

The difference between failure and success in sustaining a wellness


programme especially for the long haul is in the sound awareness of
personal capabilities and limitations. Informed choices based on facts to
support decision-making processes help to sustain interest and endurance
in fitness activities over a longer period.

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TOPIC 1 CONCEPT OF HEALTH AND WELLNESS  11

The success of any programme let alone a fitness plan is to design a


personalised course that fits individual needs and takes into account his or
her current state of health and fitness level. For the successful execution of
an effective wellness programme, a person needs to have a compelling
desire to change or adapt their present lifestyle for a more healthy option
that is well-planned to suit the individual.

For beginners, a good preparatory step is to get a proper medical check-up


and sort out any other issues so that their chosen programme would be of
the right intensity and physiologically beneficial. Usually health and
wellness experts are able to advise beginners on the right plan based on
available resources as well as their current state of health.

Last but not least, individuals should gather appropriate information by


reading wellness literature and through consultation with a health and
wellness practitioner in order to make informed decisions for a
personalised fitness programme. These tips will help you to decide on the
appropriate exercise routines and related rehabilitation methods, dietary
modifications, current state of health and targets to achieve short-term and
long-term wellness.

ACTIVITY 1.4

1. List five examples each of modifiable and non-modifiable risk


factors that can influence wellness in a person.

2. Identify two examples of negative thoughts. Discuss how they can


impact the general wellness of a person.

3. Discuss with two examples how self-centred behaviour and a


judgmental attitude can impact the general well-being of a person.

4. Recommend general strategies that would encourage more


teenagers to participate in health and wellness activities.

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12  TOPIC 1 CONCEPT OF HEALTH AND WELLNESS

1.4 INFLUENCES ON HEALTH AND WELLNESS


Now we come to a new subtopic that looks at influences on health and wellness.
Hopefully, upon completion of this subtopic, you will be able to recognise the
factors that characterise the health and wellness state of an individual.

Clearly, there are numerous factors that influence people to pursue fitness and
adopt a healthy lifestyle. Most people who are consistent in their efforts to
maintain their health do so with the firm belief of reaping a range of physical,
psychological and social benefits for themselves. Then, there are fitness buffs
who take up fitness activities after being inspired by good-looking role models.
There are still others who indulge in fitness activities solely to develop their
physique to draw attention to themselves.

Keep in mind that a realistic awareness of motives is necessary to maintain a


rational balance between the expectations of benefits from partaking in sports
and fitness activities and the risks associated to personal well-being. Besides,
participating in a wellness programme does not necessarily shield a person from
the risk of illness nor bestow permanent immunity from all major ailments. It is
just that the likelihood of developing an illness is far less than those who neglect
healthy lifestyle activities all together.

In the following subtopic, we will consider specific factors that cause people to be
susceptible to diseases, regardless of their state of fitness.

1.4.1 Predisposing Factors


What do predisposing factors mean?

Predisposing factors are characteristics in a person that motivate behaviour


towards certain habits or acts.

There are over seven billion people on this planet today. Although we are all
unique in our own ways, we are also similar in others. All humans have similar
physiological needs yet there are some socio-cultural and individual uniqueness
among us.

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TOPIC 1 CONCEPT OF HEALTH AND WELLNESS  13

There is a popular saying that we are a product of our past. Our unique traits are
in many ways influenced by genetic factors passed down from our ancestors.
Blood-linked family members are particularly vulnerable to certain diseases that
are genetically inherited. Often close family members with these chronic diseases
pass down their genetic predisposition to their offsprings. Genetic traits can carry
risks of serious chronic diseases such as diabetes, hypertension, mental disorders
and serious blood disorders like haemophilia and thalassemia.

The good news is that even though a person may have genetic predisposition
towards certain types of chronic diseases, following properly designed and
comprehensive health and wellness programmes can reduce the risks or delay
the onset of such conditions. Although you may not be able to avoid your genetic
predisposition for certain diseases, you can still make lifestyle changes to reduce
the chances of developing them. For example, if a person has a family history of
diabetes, it would be wise for him or her to start early in life to adopt suitable
lifestyle changes as a preventive strategy to reduce the risk of developing
diabetes later on.

Aside from genetic factors, the general nature of emotional responses of a person
in dealing with his or her daily life also has a significant influence on health and
wellness outcomes. Usually, a healthy person who is emotionally resilient would
be more able to rebound back easily from incidents of emotional trauma.

Apart from these dispositions, social and environmental conditions are also
significant predisposing factors that influence health and wellness. The nature
and quality of interpersonal relationships can influence a person to be positive-
minded, loving and well-adjusted. But on the flip side, it can result in a person
indulging in unhealthy and risky activities such as violence, heterosexual
practices, smoking and alcohol and drug abuse. Conforming to herd-mentality
and peer pressure are some examples of social influences that shape a personÊs
action. It is believed that children of alcoholic parents have a greater risk of
becoming alcoholic themselves, but if their social environment is altered to
become more healthy and positive, the risks can be easily neutralised.

Another predisposing factor that greatly influences health and wellness choices
are values, attitudes and beliefs that are instilled in a person from early
childhood. Children of health conscious parents are more likely to choose healthy
activities as their natural recreational pursuits. Alternatively, children brought
up in a family of obese siblings while practising poor dietary habits and
sedentary lifestyles, will be more likely to perpetuate such poor practices as
adults.

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14  TOPIC 1 CONCEPT OF HEALTH AND WELLNESS

ACTIVITY 1.5

Identify the obstacles that you may be facing yourself in pursuing a


regular health and wellness plan in your life.

1.4.2 Reinforcing Factors


Now we will examine the role of reinforcing factors that influence health and
wellness. Do you have any idea what they are?

Reinforcing factors for health and wellness are elements that help to promote
and encourage behaviours towards health and wellness options in a personÊs
life.

They are regarded as the reverse of predisposing factors as these attributes


provide added impetus to enhance the chances for certain traits to occur readily.
Usually, encouragement to persevere with a health and wellness programme is
greatly influenced by reinforcing factors. For example, displaying gory pictures
of cancer victims on cigarette packets will help to reinforce abstinence from
smoking.

Some reinforcing factors may be due to external or internal motives as they may
be linked to a variety of personal reasons for persisting with a wellness
programme. Examples of external drivers may range from wanting to look and
feel good in the eyes of peers or loved ones, to conforming to a particular social
group that espouses the importance of health and wellness.

Similarly, people with an internal sense of reward are driven by a personal


commitment to maintain their wellness. For example, let us look at marathon
runners (see Figure 1.3). What motivates them to pursue their sport?

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TOPIC 1 CONCEPT OF HEALTH AND WELLNESS  15

Figure 1.3: Marathon runners report a sense of „runnerÊs high‰


caused by the release of endorphins in their bodies after a
long distance run ă this motivates them to complete their run

ACTIVITY 1.6

Identify at least five potential benefits that could motivate an adult to


adopt a regular health and wellness programme.

1.4.3 Barriers to Wellness


Do you agree that sometimes it is very difficult to make lasting changes to habits
and behaviours? Why is it that some people are successful in maintaining an
exercise programme for long periods of time while others tend to give up after a
short try? How about you? Which category do you fall into?

There are many tangible as well as barriers that prevent the adoption of healthy
lifestyle behaviours. For example, economic factors can be a major obstacle for a
person even if he or she is very passionate about leading a health and wellness
lifestyle. A person with an average income would find it challenging to spend
money regularly on a costly fitness programme or having to purchase customary
exercise apparel.

For some people, health and wellness activities are regarded as secondary
choices compared to physiological and security needs. In addition, the nature of
occupation and work schedules also influence the continuity of a health and
wellness routine. Many people who work on rotating shifts find it hard to cope
with a regular exercise programme, particularly due to disruption of their
circadian rhythm.

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16  TOPIC 1 CONCEPT OF HEALTH AND WELLNESS

Furthermore, urban settings have been identified as another major factor that
impacts participation in health and wellness routines. Overcrowding, pollution
and lack of safety measures are major features of many urban settings, which
then discourage fitness activities. Playgrounds and recreational parks are scarce
due to the ever increasing premium on land space. The emergence of commercial
gymnasiums and fitness clubs does provide a conducive ambience for fitness, but
often these exclusive establishments are commercial in nature and cater mostly
for the well-to-do.

ACTIVITY 1.7

Discuss strategies that a shift worker could adopt in order to pursue a


regular health and wellness programme.

1.4.4 Lifestyle Influences


So far, we have considered several factors that can influence positive behavioural
changes for health and wellness initiatives. In this subtopic, let us examine the
effects of personal lifestyle choices which motivate action or delay participation
in improving oneÊs overall health and wellness state.

Generally, the choices that people make have a significant impact on the quality
and length of their lives. For example, decisions to indulge in risky forms of
behaviours can lead to detrimental consequences even in the pursuit of health
and wellness activities. Inappropriate selection of physical activities and extreme
forms of recreational indulgence increase the chances of adverse reactions and
freak accidents.

Other risks or undesirable consequences in sports include doping to enhance


performance or for recreation, smoking and alcoholism. In addition, a sudden
change in fitness levels of people who shift from a sedentary lifestyle to pursue
physically challenging activities, obesity, indulging in high risk sexual activities
without safety precautions, excessive hostility in competition, uncontrolled
aggression and poor adaptation to stress can also increase the risk of dangerous
incidents.

There are some people with delusional thinking who believe that they are
immune to negative health effects as a result of their risky behaviours.
Unfortunately, most of the time these are the people who are likely to „drop
dead‰ one day.

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TOPIC 1 CONCEPT OF HEALTH AND WELLNESS  17

ACTIVITY 1.8

1. Discuss the detrimental effects of smoking on the health and


wellness of a person.

2. Do you agree with the expression that „health is wealth‰? Discuss


your opinion with other learners.

1.5 BENEFITS OF A COMPREHENSIVE HEALTH


AND WELLNESS LIFESTYLE
What are the benefits of a comprehensive health and wellness lifestyle? What can
you gain from this lifestyle? Each dimension of a wellness activity contributes to
a set of bodily changes for overall health benefits of a person. Many of the
positive lifestyle choices a person makes today will yield short-term health
benefits as well as contribute to the overall well-being of the individual and
society.

For example, physical fitness due to regular exercise and proper dietary practices
will lead to improved cardiovascular fitness and enable a person to be involved
in team sports with friends. In fact, this will improve goodwill and cordiality
within their social circles and help reduce stress and increase self-esteem among
group members. If you make it a routine, this cycle will lead to higher levels of
personal physical conditioning along with improvements in cardiovascular
fitness as well as boost energy levels. Your actions will also help to perpetuate a
healthy culture among your friends and family. Such efforts will lead on towards
creating a healthy and happy community.

There is an extensive list of benefits that one can gain by maintaining a high
degree of wellness. Some of these benefits are listed in Figure 1.4.

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18  TOPIC 1 CONCEPT OF HEALTH AND WELLNESS

Figure 1.4: Six benefits of a comprehensive health and wellness lifestyle

These six benefits are explained further in the following subtopics.

1.5.1 Improved Cardiovascular or Heart and Blood


Vessels Efficiency
Can you explain the functions of the heart? The principle function of the heart is
to pump blood through the circulatory system to enable oxygen to reach the
body cells and remove waste matter from the cells. Therefore, an improved
cardiovascular system will maintain this function effortlessly throughout the
lifetime of a person and enable the individual to function with minimal strain.

1.5.2 Increased Muscle Tone, Strength, Flexibility and


Endurance
What can good muscle tone provide? Good muscle tone provides shape for the
body as well as the ability for limbs to move and act to fulfil daily activities.
Therefore, increased muscle strength supports economic activities that can
improve the quality of life for an individual. A physically fit person invariably
makes good choices in life, as well as enjoys flexibility and endurance against
stress and fatigue. A well-developed musculoskeletal system also protects the
body against injuries from strains and sprains. Bones and joints support the
bodyÊs movements, provide agility and strength and protect the body from
injury.

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TOPIC 1 CONCEPT OF HEALTH AND WELLNESS  19

1.5.3 Improved Self-control, Self-efficacy and


Self-esteem
People who have better control over their health seem to exude a higher sense of
self-esteem and feel good about themselves, just like in Figure 1.5.

Figure 1.5: A person with high self-esteem always feels good about himself or herself

Such feelings of goodness and self-confidence can positively impact other areas
of a personÊs life as well as people around him or her.

1.5.4 Improved Stress Management and Outlook in


Life
A healthy person is more likely to have a positive outlook at life and be able to
control stress and change perceptions that lead to an unnecessary build-up of
stress.

In addition, the person also has the potential to recover quickly from a stressful
event and is able to think clearly about options to withstand pressure. People
with self-confidence are generally better equipped to face challenges and
setbacks and see them as opportunities and growth experiences.

1.5.5 Improved Interpersonal Relationships


Did you know that successful interpersonal relationships often require complex
social dynamics? This includes an assortment of physical and psychological well-
being being present in an individual. An internal „feel good‰ factor is an
essential ingredient for a person striving to maximise his or her social appeal.

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20  TOPIC 1 CONCEPT OF HEALTH AND WELLNESS

1.5.6 Decreased Mortality and Morbidity from


Illnesses
Did you know that high levels of physical fitness support a well-functioning
immune system? Our immune systems can protect our body from infectious
diseases. In fact, reduced stress levels and proper rest, good dietary habits and
exercises improve cardiovascular fitness and optimal body functioning, which
can delay the onset of chronic diseases. All these forms of protection help to
protect the body against premature death and promote chances of rapid, full
recovery from ailments.

SELF-CHECK 1.2

Describe the benefits of a comprehensive health and wellness lifestyle.

1.6 CONCLUSION
Congratulations! You have successfully completed the first topic. It is hoped that
you have grasped the basic concepts for an individual to take personal
responsibility for his or her health and wellness. The next topic will further
expand on the concepts of wellness and provide you with a holistic view of the
eight dimensions of wellness namely; emotional, environmental, financial,
intellectual, occupational, physical, social and spiritual dimensions.

It is hoped that the understanding gained from reading this module will enrich
you intellectually and at the same time, empower you on a path of personal
wellness. All the best!

Copyright © Open University Malaysia (OUM)


TOPIC 1 CONCEPT OF HEALTH AND WELLNESS  21

ACTIVITY 1.9

1. Complete this personal health history questionnaire:

Personal Health History

1. Have any primary relatives (father, mother, siblings) suffered


coronary or other atherosclerotic disease prior to age 55?
Yes ă 1 No ă 3 Do not know ă 2
2. Do any of your primary relatives have diabetes?
Yes ă 1 No ă 3 Do not know ă 2
3. Do any of your primary relatives have osteoporosis?
Yes ă 1 No ă 3 Do not know ă 2
4. Have any of your primary relatives had cancer?
Yes ă 1 No ă 3 Do not know ă 2
5. Do any of your primary relatives have high blood pressure?
Yes ă 1 No ă 3 Do not know ă 2
6. Do any of your primary relatives have high cholesterol?
Yes ă 1 No ă 3 Do not know ă 2
7. Is your total cholesterol  20mg/dl?
Yes ă 1 No ă 3 Do not know ă 2
8. Is your blood pressure  140/90mmHg?
Yes ă 1 No ă 3 Do not know ă 2
9. Do you have medical health exams once a year?
Yes ă 3 No ă 1 Not regular ă 2
10. Are you obese (> 20lbs or 9kg over average body weight)?
Yes ă 1 No ă 3 Do not know ă 2
11. Do you smoke cigarettes?
Yes ă 1 No ă 3 Not everyday ă 2
12. Would you rate yourself as a physically inactive person?
Yes ă 1 No ă 3 Not sure ă 2

Scoring to assess risk for developing chronic diseases:


 20 High risk
21 ă 29 Moderate risk
 30 Low risk

Source: Adapted from Donatelle, Snow & Wilcox (1999)

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22  TOPIC 1 CONCEPT OF HEALTH AND WELLNESS

2. Based on your score levels, prepare an action plan for healthy


lifestyle activities for yourself. Present your plan in class and
compare your plan with others to identify similarities and
differences in approaches to activities and priorities for wellness.

3. It is said that investing in 20 to 30 minutes of regular exercises per


week can prospectively hinder 20 or more years of being bed-ridden
during old age. Referring to the preceding statement give some
examples from your own life experiences to support or negate it.

 Based on the definition by WHO (2003), health is a state of complete physical


health, mental health and social well-being; not merely the absence of illness
and infirmity. Health can also be understood as a state of well-being as a result
of vigorous balance between the emotional, environmental, financial,
intellectual, occupational, physical, social and spiritual dimensions of a person.

 Wellness is an active process through which a person becomes aware of


personal limitations to health and makes conscious choices to gain more
independence from the constraints to his or her contentment to enjoy a happy
and successful existence.

 Some characteristics of a healthy lifestyle for an individual include eating a


well-balanced and nourishing diet, maintaining a healthy body weight, regular
exercises, being able to control stress, having adequate rest and sleep,
maintaining a healthy balance between work and social activities, being able to
manage extreme emotions, being an active advocate for a healthy environment
and others.

 Personal responsibilities for attaining and maintaining health and wellness in


an individual include assuming personal accountability for actions to restore
health, showing concern for the health and welfare of others and reliance on
evidence for sound decision making on health matters.

 The quality of health and well-being of an individual are influenced by


predisposing factors, reinforcing factors and barriers to wellness.

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TOPIC 1 CONCEPT OF HEALTH AND WELLNESS  23

 Some of the benefits of a comprehensive health and wellness lifestyle include


improved cardiovascular or heart and blood vessels efficiency, increased
muscle tone, strength, flexibility and endurance, decreased mortality and
morbidity from illnesses and others.

Awareness Personal responsibilities


Barriers to wellness Predisposing factors
Body image Regular exercises
Cardiovascular or heart and blood Reinforcing factors
vessels efficiency
Self-control
Conscious personal choices
Self-efficacy
Health
Self-esteem
Healthy lifestyle
Sound decision-making
Ideal body weight
Strength, flexibility and endurance
Interpersonal relationship
Stress management and outlook
Mortality and morbidity
Well balanced and nourishing diet
Muscle tone
Wellness

Donatelle, R., Snow, C., & Wilcox, A. (1999). Wellness: Choices for health and
fitness (2nd ed.). Belmont, CA: Wadsworth.

Dunn, L. (1977). What high level wellness means. Health Values, 1(1), 9.

Edlin, G., & Golanty, E. (2010). Health & wellness (10th ed.). Sudbury, MA: Jones
& Bartlett.

World Health Organization. (2003). WHO definition of health. Retrieved from


http://www.who.int/about/definition/en/print.html

Copyright © Open University Malaysia (OUM)


Topic  Dimensions
2 of Health and
Wellness I
LEARNING OUTCOMES
By the end of this topic, you should be able to:
1. Identify eight dimensions of health and wellness;
2. Plan physical activities that will contribute to physical wellness;
3. Select the strategies to achieve balanced emotional wellness;
4. Employ the spiritual support to enhance wellness; and
5. Evaluate the significance of intellectual dimension in wellness.

 INTRODUCTION
Let us start this topic by reading the following quote from Benjamin Disraeli
(refer to Figure 2.1):

Figure 2.1: Benjamin Disraeli, former prime minister of Great Britain (from 1804 to 1881)
Source: www.azquotes.com

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TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I  25

What can you infer from this quote? Obviously, the quote in Figure 2.1 states the
importance of health. But do you know that there are other dimensions as well
that are essential to health and wellness? These are the physical, emotional,
spiritual and intellectual dimensions which are important attributes for health
and wellness.

Therefore, this topic will focus on these four dimensions ă physical, emotional,
spiritual and intellectual. Are you ready to discover more? Let us start the
journey!

2.1 DIMENSIONS OF HEALTH AND WELLNESS


Let us start off by learning the eight dimensions of wellness. Hopefully by the
end of this lesson, you will be able to identify them.

Do you agree that health is more than a matter of individual choices, family and
other social relationships? For instance, if a spouse has a serious illness, the
chances that his/her marital partner will acquire a serious illness doubles
(Stroebe et. al, 2007). This is the reason why the philosophy of holistic health
emphasises the unity of the mind, spirit and body.

Therefore, symptoms of illness and disease may be viewed as an imbalance in a


personÊs total state of being and is not simply as the malfunction of a particular
part of the body.

For example, think of the time when you had a headache. Although headaches
can be associated with brain injury or the symptoms of another illness, more
often than not it is caused by emotional stress. This produces a tightening of the
muscles on the neck or head. These contracting muscles increase the blood
pressure in the head, thereby causing the headache. Most people relieve
headaches by taking analgesic drugs or seeking other alternative remedies such
as massage to relieve the pain as it can alter physiological mechanisms that
produce the pain.

In contrast, someone may use the holistic approach as the first step to determine
the source of stress, tension, worry, anger or frustration and then plan to reduce
the emotional stress that may cause the illness.

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26  TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I

Health can also be defined as a reflection of your ability to use the intrinsic and
extrinsic resources related to each dimension of health to participate fully in the
activities that contribute to your growth and development, with the goal of
feeling a sense of well-being as you evaluate your progress through life (Payne,
Hahn & Mauer, 2005).

Did you realise that the real problem of health lies within ourselves? Even
though most people are aware of their unhealthy lifestyles such as smoking,
inactivity, high-fat diets or excessive stress, they seem satisfied as long as they
think they are free from any symptoms of diseases or illness. Therefore, they will
not change their lifestyle until they suffer a major health problem such as
hypertension, diabetes or heart problems. That is why it is important for us to
recognise that our current lifestyle habits dictate our future health and well-
being.

There are eight dimensions to wellness, namely, physical, emotional, spiritual,


intellectual, social, occupational, environmental and financial (refer to
Figure 2.2). However, for this subtopic, we will discuss the first four dimension
which are; physical, emotional, spiritual and intellectual.

Figure 2.2: Eight dimensions of wellness

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TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I  27

The description of the four dimensions that we will look into in the next subtopic
is as follows:

(a) Physical Dimension


There are many factors that contribute to the physical well-being of a
person or individual including physical fitness, regular exercise and well
balanced diet.

(b) Emotional Wellness


We can apply some strategies to achieve this by remaining flexible and
compromising in order to solve problems.

(c) Spiritual Wellness


Did you realise that in order to cope with stress, another significant
dimension is the spiritual aspect? It is the ability of a person to integrate
their beliefs and values into their actions.

(d) Intellectual Dimension


What can we say about this? This dimension is the ability of a person to
contribute ideas, think critically and seek out new challenges.

Take note that when all the dimensions to health and wellness are integrated and
function together, one will achieve a high level of wellness or optimal health.

Now, how do we achieve positive wellness? Well, in order to achieve positive


wellness, a person must be free from symptoms of disease such as pain, being
active, in good spirits and feeling emotionally healthy. In addition, the personÊs
environment (including work, school, family and community) and his or her
physical, emotional, intellectual, occupational, spiritual and social dimensions of
wellness must also be in tune with one another in order to produce harmony.

As stated before, these dimensions are interrelated; one frequently affects the
others. For example, a person who is emotionally down often has no desire to
exercise, study, socialise with friends, or attend mosque or church and may be
more susceptible to illness. Therefore, these eight dimensions of wellness will
show you how the concept clearly goes beyond the absence of disease.

SELF-CHECK 2.1

State the eight dimensions of wellness.

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28  TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I

2.2 PHYSICAL DIMENSION


This subtopic introduces some physical activities that can contribute to physical
wellness. Hopefully by the end of this subtopic, you can plan your own physical
activities in order to stay fit and healthy.

Let us learn more on the first dimension of wellness which is physical. What does
it mean to be a physically well individual?

Physically well individuals are those who are


physically active, exercise regularly, eat a well-
balanced diet, maintain the recommended body
weight and minimise exposure to environmental
contaminants.

In addition, people in good physical condition also avoid harmful drugs and
smoking as well as seek medical care as needed and participate in activities that
help prevent illness.

Naturally, good/ideal physical fitness is characterised by good cardiorespiratory


endurance, enhanced adequate muscle strength, flexibility and proper body
composition. Therefore, the physically fit person will be able to carry out the
ordinary and challenging demands of daily life safely and effectively.

How does one achieve such a condition? We will look briefly at one big factor
that contributes to the physical wellness of a person, which is physical fitness.

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TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I  29

Nowadays, most people recognise that participating in fitness programmes


would improve their quality of life. On the other hand, we must remember that
improving physical fitness alone is not sufficient to lower the risk for disease and
ensure better health. Let us study the following scenario:

Jim Fixx (refer to Figure 2.3) is the famous author of the best seller book
entitled The Complete Book of Running. He died at the age of 52 due to heart
attack, although he had been running between 60 and 80 miles a week.

Figure 2.3: Jim Fixx (from 1932 to 1984)


Source: www.allouteffort.com

He believed that his high level of fitness would prevent dying from heart
attack. At age of 36, Jim Fixx smoked two packs of cigarettes per day, and did
not participate in regular physical activity and had a family history of heart
disease.

His father had his first heart attack at the age of 35 and died when he was 43
years old. Jim Fixx began to raise his level of fitness. He started to jog and quit
smoking. On several occasions, he declined to have electrocardiogram (ECG)
test, which would likely have revealed his cardiovascular status.

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30  TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I

Now, what can you say as a conclusion to the given scenario? It illustrates that an
exercise programme itself is unable to make high-risk people immune to heart
disease, though it may delay the onset of cardiac arrest. What kind of exercises
can you practise to achieve physical fitness? Well, let us look at Figure 2.4 for
some examples.

Figure 2.4: Examples of physical fitness exercise


Source: http://www.fitnesshealtytips.com

Therefore, it can be said that physical wellness requires implementing positive


programmes in order to change behaviours to improve health and quality of life.

2.2.1 What is Physical Fitness?


How can we define physical fitness?

„Physical fitness is defined as the ability to meet the ordinary as well as the
unusual demands of daily life safely and effectively without being overly
fatigued and still have energy left for leisure and recreational activities‰.

(Hoeger & Hoeger, 2003)

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TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I  31

Did you realise that when you choose to commit to physical activities as a way of
life, you will regularly exercise in order to keep fit? Aside from that, when you
are pursuing your physical fitness activities, you will probably meet other
healthy and active people. Through this, you will be able to expand your circle of
friends.

2.2.2 Developing a Cardiorespiratory Fitness


Programme
Did you know that for people of all ages, cardiorespiratory conditioning can be
achieved through many activities? This is true as long as the activities you choose
place sufficient demands on the heart and lungs which will improve physical
fitness. The familiar activities such as swimming, running, cycling, aerobic, brisk
walking, skating and even some weight training will produce cardiorespiratory
fitness. Regardless of age or physical limitation, you can select from a variety of
enjoyable activities to improve your cardiorespiratory system.

Let us look at the recommendation for achieving cardiorespiratory fitness from


The American College of Sport Medicine (ACSM). ACSMÊs (2000) most recent
recommendation is to include four major areas (refer to Figure 2.5).

Figure 2.5: Four areas to achieve cardiorespiratory fitness


as recommended by the American College of Sport Medicine

These four areas are further described as follows:

(a) Mode of Activity


The ACSM recommends the mode of activity to be any continuous physical
activity that uses large muscle groups, and can be rhythmic and aerobic in
nature. Can you name some of these activities? Well, among the activities
are continuous swimming, cycling, aerobic, basketball, walking and
running. Just take note that regardless of which continuous activity you
select, it should be enjoyable. You should also vary your activity to prevent
boredom.

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32  TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I

(b) Frequency of Training


What does frequency of training refer to? Frequency of training refers to the
number of times per week a person should go for exercise. So how many
times are appropriate? Is it a few hours per day or per week? ACSM
recommends exercising three to four times per week.

(c) Intensity of Training


How much effort should you put into an activity? Which one would you
prefer; a quick run, a slow jog or a swim at a comfortable pace? Must a
person sweat profusely to become fit? The intensity is the number of
exercise sessions per week; for aerobic fitness 50% to 85% of your heart rate
range is recommended. The level of intensity is called target heart rate
(THR).

ACSM also recommends that healthy adults exercise at an intensity level


between 65% and 90% of their maximum heart rate. You should be aware
that there should be considerable difference between your estimated
maximal heart rate and your actual maximal heart rate. For example, a
younger person, for example, a 20-year-old person with a resting heart rate
of 60 beats/min, would need to participate in a continuous activity for an
extended period while working at a THR of 158 beats/minute. Whereas an
older person, for example, a 40-year-old person with a resting heart rate of
80 beats/min, would need to function at a THR of 150 beats per minute to
achieve positive training effect.

(d) Duration of Training


ACSM recommends that the duration of training should be between 20 and
60 minutes of continuous activity. Those who choose activities with low
range of intensity of 50% to 60% of heart rate range should maintain the
activity for longer period of time. Thus, a fast jog and a moderate walk will
require different amounts of time to accomplish the training effect.

As a conclusion, we can say that a person with physical wellness is able to:

(a) Exercise regularly and select a well-balanced diet;


(b) Make informed choices about medicine used and medical care; and
(c) Maintain a positive health-promoting lifestyle.

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TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I  33

ACTIVITY 2.1

Select an exercise programme by Leslie Sanson entitled Three Fast Miles


via YouTube at http://goo.gl/24avKi.

Appoint an instructor and start the exercise for the first 15 minutes.

Then discuss the effect of the exercise in the group.

SELF-CHECK 2.2

1. Fitness is composed of four components ă cardiorespiratory


endurance, muscular fitness, flexibility and body composition.
Discuss in depth the component of cardiorespiratory endurance in
physical fitness.

2. Discuss the health benefits that can be achieved through regular


moderate exercise.

3. Write objectives to improve your fitness and wellness and develop


a wellness programme for the future.

2.3 EMOTIONAL DIMENSION


Now let us look at another dimension of wellness which is emotional. It is hoped
by learning about this dimension, you will be able to select suitable strategies to
achieve balanced emotional wellness.

The emotional dimension of health encompasses the ability to cope with stress
such as remaining flexible and compromising to resolve problems. Please note
that our ability to cope with stress will change as we age and as we learn new
skills of managing our emotion. For example, young adults who are in the
process of growth and development will experience emotional vulnerability,
which may lead to feelings of rejection and failure. This can affect productivity
and self-satisfaction (refer to Figure 2.6).

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34  TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I

Figure 2.6: Illustration of emotional vulnerability


Source: http://media.cagle.com

On the other hand, the emotional dimension of wellness involves developing


awareness and accepting oneÊs feelings. For instance, emotionally well people are
able to express and manage their feelings effectively, maintain close
relationships, deal with conflicts and remain grounded during stressful times.
This is part of the continuous process of change and growth for young adult.

2.3.1 Emotional Stability


How do we relate emotional wellness with emotional stability? The answer lies
within the definition of emotional wellness.

Emotional wellness is defined as the ability to understand our own feelings,


accept limitation and achieve emotional stability.

In other words, it is the ability to express emotions appropriately, accept change


and cope with stress in a healthy way, and to enjoy life despite disappointments
and frustrations.

Now, what can we say about emotional stability? What does it stand for?

Emotional stability is also the ability to look at success and failure in a


positive manner.

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TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I  35

When success is evident, people who are emotionally well radiate with expected
joy. On the contrary, when failure seems imminent, they respond by making the
best of circumstances and move beyond failure.

Last but not least, emotional wellness also involves happiness; it is seen as a long
term state of our mind that permeates the various facets of life and influences our
outlook. In other words, it means that true happiness signals exemption from
tension and depression that many people endure.

2.3.2 Self-concept
Now we will discuss self-concept and self-esteem as part of emotional health.
Firstly, the definition of self-concept. Do you have any idea what it means?

Self-concept is how an individual pictures himself/herself internally, the


way one sees oneself.

Self-concept is also the informational side of things, where you know facts about
yourself. What about self-esteem?

Self-esteem is how you feel about your own character and abilities. For
example, whether you enjoy the fact that you are talkative (high self-esteem)
or you think that you are annoying (low self-esteem).

Therefore, how can we achieve balanced emotional wellness? Well, here are some
practices that will help to enhance your emotional wellness:

(a) Recognising conflict as potentially healthy rather than denying it;


(b) Being responsible for your actions;
(c) Reflecting on your feelings;
(d) Accepting your feelings instead of denying them;
(e) Accepting the feelings of others;
(f) Seeking support, and guidance for uncontrollable feelings and emotions;
(g) Building sturdy social support network;

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36  TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I

(h) Practising positive financial behaviours to enhance security and emotional


stability; and
(i) Being open to continual personal and professional development.

We can summarise that a person with emotional wellness will be able to:

(a) Possess a sense of humour;


(b) Recognise own feelings and appropriately express them;
(c) Strive to meet emotional needs; and
(d) Be responsible for his or her behaviour.

SELF-CHECK 2.3

Differentiate between self-concept and self-esteem.

ACTIVITY 2.2

1. Emotional growth requires both knowing about yourself and


learning from new experiences. Consider the following scenario:

Azman is a 30-year-old learner. He feels that he is being pulled in


many different directions. Sometimes he thinks he is losing his
sense of self or wonder if he ever had one. What can he do to help
himself grow emotionally?

Select the activities that you think can be used to foster AzmanÊs
emotional growth. Discuss your plan in a group.

2. Discuss strategies that can be implemented to enhance oneÊs self-


motivation.

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TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I  37

2.4 SPIRITUAL DIMENSION


This subtopic covers the spiritual dimension. Hopefully, you will be able to
employ the spiritual support to enhance your wellness.

The spiritual dimension of wellness is another endeavour after emotional


wellness. The spiritual dimension of wellness involves exploring meaning and
purpose in human existence. How do we recognise spiritual people? We can
recognise them by their basic characteristics which include a sense of meaning
and direction in life, and their relationship to the Creator. These characteristics
then lead to personal freedom, prayer, faith, love, closeness to others, peace and
altruism. Therefore, people with spiritual dimension of wellness possess the
ability to integrate their beliefs and values into their daily actions.

Please note that spiritual dimension of wellness is closely connected with


religious beliefs and activities. Attending religious activities or meditation will
not only result in better health by lowering the incidence of chronic disease, but
also helps us handle stress more effectively (see Figure 2.7).

Figure 2.7: Animated stages on meditation


Source: http://www.meditationcartoons.com

In fact, religious activities or meditation can also have a positive effect on our
social lifestyle as they may help us in overcoming crisis and provide us with
better coping techniques to deal with future trauma.

Furthermore, in the spiritual dimension, prayer is the core of most spiritual


experiences as a mode of communicating with our Creator. However, for
effective results, we need to accept the efficacy of prayer and pray with sincerity,
humility and love.

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38  TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I

Another key term under the subject of spiritual dimension is altruism. What does
it stand for?

Altruism means true concern for the welfare of others which enhance oneÊs
health and longevity.

Did you know that altruism is a powerful attribute? It is so powerful that even
watching films of altruistic endeavours would enhance the formation of an
immune system which helps fight disease.

What can we practise to increase our spiritual wellness? Well, here are some
practices that can be adopted to increase your spiritual wellness:

(a) Possess a set of guiding beliefs;


(b) Respecting beliefs and values of others;
(c) Living in a way that is consistent with your principles;
(d) Taking time for prayer or meditation;
(e) Aware of the deeper meanings of everyday events; and
(f) Spending time with nature.

To conclude, a person with spiritual wellness is able to:

(a) Examine his or her own personal values and beliefs;


(b) Search for meanings that help explain the purpose of life;
(c) Have a clear interpretation of right and wrong; and
(d) Acknowledge natural forces in the universe.

Copyright © Open University Malaysia (OUM)


TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I  39

ACTIVITY 2.3

1. Form a group and sit in a circle position. Prepare for a meditation


exercise by playing background music on sounds of nature for a
duration of 10 to 15 minutes. Discuss your experience with the
group. Determine your level of tension and stress. Lastly,
formulate a stress management programme for the group.

2. What is the role of religion or spirituality in our health? To what


extent should spirituality be part of the clinical encounter between
patient and healthcare providers?

2.5 INTELLECTUAL DIMENSION


Finally, we come to the final subtopic which focuses on the intellectual
dimension. It is hoped that by learning this dimension, you will be able to
evaluate the significance of the intellectual dimension in your wellness.

What is the intellectual dimension?

Intellectual dimension is the ability to process and act on information, clarify


values, beliefs and decision-making.

On other hand, intellectual wellness refers to active participation in scholastic,


cultural and community activities. Besides that, other approaches such as valuing
and nurturing creativity, curiosity and lifelong learning are part of intellectual
wellness too. Hence, intellectually well people are open to new ideas, able to
think critically, seek out new challenges and are more likely to maintain good
cognition even as they age.

In the other words, when you possess positive intellectual dimension, you are
not intimidated by facts and figures with which you are unfamiliar, but you
embrace the chance to learn something new. You are self-motivated to enhance
your life in terms of further studies or professional development while holding
your own ideas and philosophies.

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40  TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I

Furthermore, you will gain self-confidence which guarantees that you can take
your place among others without having to give up part of yourself and without
requiring others to do the same. Let us look at Figure 2.8 which shows you an
example of self-motivation quotes.

Figure 2.8: Example of self-motivation quotes


Source: https://s-media-cache-ak0.pinimg.com

What can we do to enhance our intellectual wellness? Well, here are some
practices that will enhance your intellectual wellness:
(a) Learning to trust your ability to make good decisions;
(b) Recognising and valuing learning as a life-long learning process;
(c) Developing creativity and resourcefulness;
(d) Being discerning when taking in information from TV, the Internet and
newspaper; and
(e) Critically analysing situations and solving problems.

As a conclusion, a person with intellectual wellness is able to:

(a) Communicate effectively orally and in writing;


(b) See the bigger picture;
(c) Keep abreast of current issues; and
(d) Exhibit good time management skills.

Copyright © Open University Malaysia (OUM)


TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I  41

ACTIVITY 2.4

Reflect on your life experiences when you have been seriously ill.

(a) Describe how you feel about the nature and duration of the
illness.

(b) Discuss all the factors that you think might have contributed to
your becoming sick.

(c) Summarise all the factors that contributed to your getting well.

(d) What do you think were the most important factors that led to
your sickness?

(e) What do you think were the most important factors in your
healing process?

(f) Write your reflective journal based on the above statement.

Please note that you need to include factors such as stress, emotional
problems and poor nutrition. Also, you may include medical care,
prayer, alternative medicines and other factors too.

 There are eight dimensions to wellness, namely, physical, emotional,


spiritual, intellectual, social, occupational, environmental and financial. In
this topic, we have discussed the first four dimensions ă physical, emotional,
spiritual and intellectual.

 Physical activities that contribute to physical wellness are exercising


regularly, taking a well-balanced diet, maintaining ideal body weight and
minimising exposure to the environmental contaminants.

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42  TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I

 Some strategies to achieve balance emotional wellness are:

 Recognising conflict as potentially healthy rather than denying it;

 Being responsible for your actions;

 Reflecting on your feelings;

 Accepting your feelings instead of denying them; and

 Accepting the feelings of others.

 Spiritual support to enhance wellness are:

 Possessing a set of guiding beliefs;

 Respecting others beliefs and values;

 Living in a way that is consistent with your principles;

 Taking time for prayer or meditation;

 Awareness of the deeper meanings of everyday events; and

 Spending time with nature.

 Intellectual dimension in wellness is the ability to process and act on


information, clarify values, beliefs and decision-making.

 The significance of the intellectual dimension in wellness is that a positive


intellectual dimension makes you more open to new ideas, able to think
critically and seek out new challenges and more likely to maintain good
cognition as you age.

Altruism Physical wellness


Emotional wellness Prayer
Intellectual wellness Spiritual wellness

Copyright © Open University Malaysia (OUM)


TOPIC 2 DIMENSIONS OF HEALTH AND WELLNESS I  43

American College of Sports Medicine (ACSM). (2000). Guidelines for exercise


testing and prescription. Baltimore, MD: Williams & Wilkins.

Edlin, G., & Golanty, E. (2010). Health and wellness (10th ed.). Sudbury, MA:
Jones & Bartlett.

Hoeger, W. K., & Hoeger, S. S. (2003). Lifetime physical fitness and wellness:
A personalized program (7th ed.). Belmont, CA: Thomson Wadsworth.

Payne, W. A., Hahn, D. B., & Mauer, E. B. (2005). Understanding your health
(8th ed). New York, NY: McGraw-Hill.

Stroebe, M., Schut H., & Stroebe, W. (2007). Health outcomes of bereavement.
The Lancet, 370(9603), 1960ă1973.

Copyright © Open University Malaysia (OUM)


Topic  Dimensions
3 of Health and
Wellness II
LEARNING OUTCOMES
By the end of this topic, you should be able to:
1. Apply the strategies to enhance social wellness;
2. Evaluate the factors that contribute to occupational wellness;
3. Plan the strategies to promote environmental awareness; and
4. Interpret financial wellness.

 INTRODUCTION
Can you still recall what the eight dimensions of wellness are? Can you list them?
Well, the answers are mental, spiritual, occupational, environmental, financial,
emotional, social and physical. In the previous topic, you have learnt the first
four dimensions of wellness which are physical, emotional, spiritual and
intellectual dimensions. Therefore, this topic will continue with the rest of the
dimensions ă social, occupational, environmental and financial.

Before we continue, let us reflect a little. Are you working and furthering your
studies at the same time? How do you cope between them? Do you realise that
occupational dimension of wellness is important for you? Occupational
dimension of wellness is important to working adults. This is because they have
to balance between studies and work, parenting and other responsibilities.

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TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II  45

So how do you balance your life with your study, family and work
commitments? How about your social interaction skills? Are you able to
participate in a group discussion? As a distance learner, you are expected to
share your ideas, experience and knowledge with your course mates through
interaction in the classroom or online discussion.

Therefore, occupational and social skills are two important dimensions to be


discussed in this topic along with the environmental awareness and financial
aspects. Remember that all the eight dimensions are interconnected and influence
each other. Are you ready to learn more? Let us continue with the lesson!

3.1 SOCIAL DIMENSION


Let us start the discussion by looking at the social dimension. Hopefully by
learning this subtopic, you will be able to apply the strategies to enhance you
social wellness.

What can we say about the social dimension?

Social dimension is described as the relationships that you have and how
you interact with others.

In other words, this dimension involves building healthy, nurturing and


supportive relationships with others to foster a genuine connection between you
and your colleagues or those around you. Therefore, this subtopic will explore
the significance of social dimension towards health and wellness especially to the
young adult.

The social dimension encourages us to involve or contribute to oneÊs


environment and community. Thus, it is more on the interdependence between
you and nature; you will feel that you are more aware of your importance in
society as well as the impact you have on multiple environments. At the same
time, you need to get involved or take an active part in improving our world by
encouraging healthier living or healthy lifestyle and initiating better
communication with those around you.

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46  TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II

So how do you achieve that? Well, in order to achieve social wellness, you need
to actively seek ways to preserve the beauty and balance of nature. As you go
along the pathway, you may discover the power to make wise choices to enhance
personal relationships, the importance of friendships and finally build a better
living space and community.

How can we develop our personal social skills? Are they inherited from your
parents? Or developed through life experience? Appropriate social skills are
developed and nurtured throughout oneÊs adult years. During the process of
becoming a young adult, we develop many interactions and form relationships
with friends, work-mates and even parents. This may enable a person to develop
social skills effectively beyond levels that they have achieved before.

Therefore, for the young adult to achieve social wellness skills, they need to
refine a variety of social skills including effective communication skills, listening
skills and conflict management skills. In other words, it is a circle of social
adaptations that we will naturally go through unconsciously as we age. The
circle begins with family interactions, school experiences and peer group
interaction that foster social skills development among young adults (see
Figure 3.1).

Figure 3.1: Circle of social adaptations that foster


social skills development among young adults

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TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II  47

At a later stage, we will develop new social skills with our colleagues when we
enter college. The interaction at the higher institution will enhance the social
dimension of health among the students, lecturers and others. Thus, the social
dimension entails valuing living in harmony with course mates and housemates,
seeking positive, interdependent relationships with others and developing good
communication skills.

This later develops into social wellness. What does social wellness refer to?
Basically, social wellness refers to the ability to communicate and relate with
others with a positive self-image. This positive self-image means that you are
confident, outgoing, friendly and affectionate toward others. In addition, your
own balance and sense of self allows you to extend respect and tolerance to
others.

On the other hand, social wellness is not only concerned about oneÊs self, but also
an interest in humanity and the environment as a whole. Socially well adapted
people are consciously enhancing their personal relationships, nurturing the
importance of friendships to build a caring community. In other words, being
socially well adapted will enhance your physical and emotional well-being.

Today, we have another term named „social media‰. What does social media
represent? Well, let us look at Figure 3.2 for the answer.

Figure 3.2: Social media is the modern communication mode


Source: http://wronghands1.wordpress.com

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48  TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II

How can we enhance our social wellness? Below are some suggestions of
practices that can enhance our social wellness:

(a) Create good rapport with others by building a strong social support
network;

(b) Practise effective communication skills with others;

(c) Involve in many activities with people in a variety of settings;

(d) Solve interpersonal conflict in a healthy environment and respectful


manner;

(e) Interact with people of other cultures, backgrounds and beliefs; and

(f) Value the principles of time management.

In conclusion, social wellness is the ability of a person to develop relationships


with friends and others. Such a person will have effective communication skills,
contributes to the common welfare of the community, and live in a harmonious
and healthy environment.

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TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II  49

ACTIVITY 3.1

1. Using the Social Wellness Assessment by Hettler (1976), answer


all the following questions and share your scores with your course
mates.

Social Wellness Assessment

The social dimension of wellness involves developing, nourishing and


encouraging satisfying relationships. Read each statement carefully and
respond honestly using the following score:

Sometimes/
Almost always Very seldom
occasionally
= 2 points = 0 point
= 1 point

Statement Score
I contribute time and/or money to social community projects.

I am committed to a lifetime of volunteerism.

I exhibit fairness and justice in dealing with people.

I have a network of close friends and/or family.


I am interested in others, including those from different
backgrounds than my own.
I am able to balance my own needs with the needs of others.
I am able to communicate and get along with a wide variety
of people.
I obey the laws and rules of our society.
I am a compassionate person and try to help others when I
can.
I support and help my family, neighbourhood and work
social gatherings.
Total for Social Wellness Dimension

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50  TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II

Score (Points) Description


15 to 20 Excellent strength in this dimension.

9 to 14 There is room for improvement. Look again at the


items in which you scored 0 or 1. What changes can
you make to improve your score?

0 to 8 This dimension needs a lot of work. Look again at this


dimension and challenge yourself to begin making
small steps toward growth here. Remember that the
goal is balanced wellness.

2. Discuss the significance of social media in enhancing social wellness


among young adults.

3. Discuss the advantages and disadvantages of social media in


promoting social wellness.

SELF-CHECK 3.1

Identify the six factors that contribute to social wellness.

3.2 OCCUPATIONAL DIMENSION


Now let us move on to the sixth dimension of wellness which is occupational. It
is hoped that by learning this dimension, you will be able to evaluate the factors
that contribute to occupational wellness.

Try to reflect on these questions about yourself: Are you happy with your current
job? Do you feel stress at work? What are the factors that contribute to your stress
at the workplace? Well, these questions are related to occupational dimension.
Let us discuss more on this matter, starting with its definition.

Occupational wellness is described as routine demands which are mixed


with new and unpredictable challenges that keep a job exciting, meaningful
and rewarding.

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TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II  51

It also entails seeking for personal satisfaction and enrichment in oneÊs life
through work. If you are able to achieve occupational wellness, you will find
personal self-fulfilment and make a contribution to the well-being of the
institution or community at large. In other words, occupational wellness is
employment that provides personal satisfaction and enrichment in oneÊs life.

The World Health Organization (WHO) (1994) stated that up to 58% of the
worldÊs population spend one third of their adult life at work. We contribute
actively to the development and well-being of themselves, our families and of
society.

This statistics means occupational wellness forms a crucial part of our overall
sense of well-being. Trying to achieve a balance between work and no work
related activity is the key to occupational wellness. Managing workplace
stressors and building functional relationships with colleagues will contribute to
your sense of occupational wellness too.

Occupational wellness is also seen as a person doing exactly what he or she


wants to do in life, that he or she feels comfortable with. This is related to their
personal and professional development, financial situation and future plans.
Hence, for many people, a healthy workplace environment that contributes to
their sense of well-being need not be tied to a high salary or prestigious position.

Salary might be the most important element for some people, but to others, it is
more on value and creativity or work commitment. Conversely, to some people,
the most important thing is the rewards rather than the job as people with
occupational wellness will also face demands on the job. However, they also
have some say over demands that are placed on them.

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52  TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II

Let us move on to the key issues in occupational wellness. What are they? Well,
there are six key issues related to this dimension as described in Table 3.1.

Table 3.1: Six Key Issues in Occupational Wellness

Issue Description
Stress Ability to handle the stress that you are dealt every day at workplace.

Rewarding Situations that you find personally rewarding.

Satisfaction Workplace environment or situations that are meaningful and create a


feeling of personal satisfaction.

Relationship Ability to create and maintain interactions and relationships with


people in the workplace.

Contribution Ability to make contributions to the well-being of others and the


community that will lead to a satisfying and meaningful feeling of
being a contributing member to society.

Balance Ability to get all our work done, besides having fun, and keeping the
rest of our lives and other dimensions of wellness balance.

So, what would be the factors that contribute to occupational wellness? How do
you encourage the culture of occupational wellness at your workplace? How
about recognition from your superior or employer? Are they really appreciative
of your contribution?

You need to find ways to engage in creative and stimulating activities that allow
you to maximise your skills or broaden existing skills and gain new ones. You
can also take the opportunity for advancement and recognition of achievement.
Not to forget to encourage collaboration and interaction among co-workers,
which foster a sense of good teamwork and support.

In addition, occupational wellness will allow you to find a path to explore your
creativity, problem solving skills, and ways to learn more about your personal
interests and the world around you. Furthermore, you can keep up with current
events, find new ideas and to satisfy your intellectual curiosity that will allow
you to continue to grow.

However, occupation wellness may have positive or adverse effects on the health
of the workers. In actual circumstances, work provides the income and material
outputs that are necessities for life and at the same time, also have a positive
impact on social, psychological and physical well-being. Moreover, a high level
of occupational wellness will contribute to the achievement of material and

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TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II  53

economic objectives that will provide high quality and performance in the
workplace.

Unfortunately, choosing and obtaining a career that is personally and financially


rewarding and enjoyable is difficult to achieve. Therefore, here are some
suggestions to enhance your occupational wellness:

(a) You may have to find out what type of occupation interests you. Are you
doing what you want to do with your life? Choose a career which is
consistent with your personal values, interests and beliefs.

(b) Learn how to achieve the right work life balance. You need to understand
your work and learning styles so that you are able to work both
independently and with others.

(c) Be aware of your strength and weaknesses by exploring your talents and
interests. You should talk to your manager or co-workers when a problem
arises. Believe that you have the qualities of a valuable employee and is
valued by others.

(d) Commitment to contribute your unique skills for personal and professional
development (in a meaningful and rewarding way).

(e) Maintain a healthy work-life balance and seek professional development


opportunities.

(f) Lastly, do not forget to have some hobbies/interests/activities which bring


you pleasure outside of work activities.

In conclusion, to achieve the occupational wellness, you need to choose a career


that is consistent with your personal values, interests and beliefs. Thus, those
with high occupational wellness will:

(a) Be involved in the exploration of new ideas;

(b) Encourage stimulation, mental growth and intellectual activities; and

(c) Make a huge difference in how they deal with situations as they project
positive image and energy which can be a healing force to those around
them.

Therefore, the choice of profession, job satisfaction, career development and


personal performance are the most important components of occupational
wellness.

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54  TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II

SELF-CHECK 3.2

1. Define what occupational wellness is.

2. State the most important components of occupational wellness.

ACTIVITY 3.2

1. Discuss, in a group, the strategies to enhance occupational


wellness at your workplace.

2. Write a reflective journal on your work experience and relate it to


occupational wellness.

3.3 ENVIRONMENTAL DIMENSION


Now let us move on to the environmental dimension. What is environmental
wellness? Are you aware of the importance of environmental wellness? Indeed, it
is important to lead a lifestyle that is respectful of our environment. Now, let us
discuss environmental wellness in depth, so that by the end of this subtopic, you
will be able to plan some strategies to promote environmental awareness.

Firstly, what does environment wellness mean?

Environmental wellness is described as a lifestyle that is supposed to be


respectful of and in harmony with our environment.

In other words, you should be aware of the limits of the earthÊs natural resources
and the impact of our actions on the environment. Environmentally well people
consciously choose to live in ways that protect the world around them.

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TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II  55

However, in todayÊs climate, many people may still be unconcerned about what
they can do to help with environmental wellness. As an individual, you do not
have to be a member of an organisation. You can help by simply leading an
environmentally conscious life.

How do you contribute to environmental wellness? Well, you can contribute by


emphasising the importance of living in a healthy environment by ensuring the
purity of water, air and living conditions. At the same time, if you see someone
littering, what you should do is just politely tell that person you do not approve
of his or her actions.

You may contribute to increasing environmental wellness by getting actively


involved in your community recycling programmes, by educating the
community on the significance of the programme, and implementing a recycling
programme such as finding ways to conserve the use of paper in your home and
workplace.

Do not forget to have regular meetings with your community or society to ensure
they support and are actively involved in the programme. Make sure the
recycling bins available in your home and workplace are being utilised (see
Figure 3.3).

Figure 3.3: Recycling bins


Source: http://recyclingrangers.blogspot.com

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56  TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II

Environmental wellness also includes the ability to promote measures that


improve the standard of living and quality of health in our environment. Hence,
it is actually our personal, community and societyÊs responsibility to educate and
protect us against environmental hazards.

It is important to note that we also need to protect the environment so that our
children and our future generations can live in a safer and clean environment.
For example, if we take account of the recent haze problem that affected our
environment, most of us were unaware of its danger to our health. We need to
educate people to take this situation seriously in order to keep their family and
children safe from haze. This is to prevent any sickness as haze causes many
respiratory problems as well as skin diseases (refer to Figure 3.4). Therefore,
precautions and quick judgment against environmental pollution may lead to
environmental wellness.

Figure 3.4: Haze hazard


Source: https://s-media-cache-ak0.pinimg.com

Have you heard about the environmental theory? What does it mean?

Environmental theory is a theory formulated by Florence Nightingale (the


founder of modern nursing) in which she focused on taking care of the
patient's environment in order to reach health goals and cure illness.

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TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II  57

Basically, the focus of this model in nursing is to alter the patientÊs environment
in order to affect change in his or her health. Florence Nightingale believed that
the environmental factors will affect health (as described in the theory) such as
fresh air, pure water, sufficient food supplies, efficient drainage, cleanliness of
the patient and bright light (particularly direct sunlight). In case any of these
factors is lacking, the patient may experience diminished health.

However, some aspects of the theory may not be relevant in todayÊs


environment. Do you know why? Let us take direct sunlight and good
ventilation for instance. Nightingale mentioned that the door should be closed
and windows opened, in order to let in direct sunlight and provide good
ventilation. However, in the real situation today, all doors and windows are
closed as we are using air conditioning system in the hospitals.

In situations where the air conditioning system is not in place, windows and
doors are opened to allow free movement of air and ventilation but still, they
should be checked for efficiency to ensure the air is free from microorganisms. In
order to ensure environmental safety in the hospital, all the air condition
systems, especially in the operation theatre, must be checked regularly to detect
the presence of any microorganism.

So, how do we enhance environmental wellness? Well, here are some tips for you
to practise:

(a) You may prefer to ride a bicycle instead of drive a car;

(b) You need to appreciate and respect nature;

(c) You need to protect yourself and others from environmental hazards. It
could be from second hand smoke, noisy environment, air and water
pollution, and also ultraviolet radiation; and

(d) You need to educate yourself on environmental issues.

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58  TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II

ACTIVITY 3.3

1. In a group, discuss the following environmental wellness issues:

(a) Awareness of the limits of the earthÊs natural resources.


(b) Conserve energy such as switch off unused light.
(c) Recycle paper, cans and glass as much as possible.
(d) Enjoy, appreciate and spend time outside in natural settings.
(e) Do not pollute the air, water or earth if you can avoid doing
so.
(f) Avoid second-hand smoke.

(www.definitionofwellness.com)

Plan suitable activities for each issue to enhance environmental


awareness among community/population.

2. Discuss some strategies to inculcate environmental awareness


among your community today.

3.4 FINANCIAL DIMENSION


Lastly, let us look at the financial dimension. Hopefully, by the end of this
subtopic, you will be able to interpret financial wellness.

Did you realise that financial wellness is a relatively new dimension? It is


considered new as it is the last dimension of health and wellness. It was generally
adopted as the eighth dimension in the aftermath of the Great Recession of
December 2007 to June 2008.

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TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II  59

So what does financial wellness mean? Let us look at a definition given by


LiveLifeWell.co (2015).

„Financial health and wellness can be defined as a „state‰, „level‰ or


„quality‰ of a personÊs financial position or wealth. Wealth can be created,
conserved or lost and will fluctuate between changing circumstances.‰
LiveLifeWell.co (2015)

The changing circumstances can be various. Some of them are amenable to


control while some are not. Knowing the characteristics of each of the relevant
forces during the period is of utmost importance. The idea is to enable one to
undertake adequate steps to minimise the exposure of oneÊs asset to the negative
effects of the environmental forces.

3.4.1 The Impetus that Led to the Creation of a


Financial Wellness Programme
The National Bureau of Economic Research (NBER) in 2014 dated the beginning
of the recession as December 2007. In the US, roughly 8.7 million jobs were shed
from February 2008 to February 2010. The gross domestic product (GDP)
contracted by 5.1%, making the Great Recession the worst since the Great
Depression.

In addition, the Great Recession led to:

(a) Unemployment and underemployment;


(b) Job shortage; and
(c) Falling income, rising poverty.

The recession led to the bursting of the housing bubble and the nose-diving of
the stock market and the consequent drop in family wealth. A great deal of stress
ensued too.

People become stressed over money and this has taken both a mental and
physical toll on workers, impacting health-related costs and reducing
productivity by a significant number.

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60  TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II

3.4.2 Financial Wellness at the Workplace


Did you know that assessment of findings at workplaces indicates financial
problem as the main determinant of financial stress among employees? Those
with higher level of financial problems experienced higher level of financial
stress which led to the decline of the level of financial well-being.

However, it is observed that among all predictors, financial stress has the highest
effect (a negative effect) on financial well-being. It can be assumed that reducing
the level of employeesÊ financial strain will improve their satisfaction towards
finance aspects.

In addition to meeting regulatory obligations to monitor employeesÊ trading


activity, some firms offered financial education and wellness programmes to
help improve their employeesÊ ability to manage their personal finances.
Financial wellness programmes may help reduce employee absenteeism, boost
productivity and increase employeeÊs loyalty.

We are sure you agree that employeesÊ financial problems become the employerÊs
problems as well. Financial wellness and the workplace that fosters it can go a
long way towards providing solutions that increase productivity and peace of
mind. Employees who experience financial wellness are happier and potentially
more productive employees to the company.

SELF-CHECK 3.3

State three benefits of financial wellness programme to employees.

ACTIVITY 3.4

Read Delafrooz, N., & Paim, L. (2013). Role of financial stress on


relationship between financial problem and financial wellness among
Malaysia workers. African Journal of Business Management, 7(20),
1966-1972 at http://goo.gl/MDdUMw.

In groups of four, discuss the interrelationship among financial


problem, financial behaviours, financial stress and financial wellness.

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TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II  61

 Social wellness is about the relationship with others. It involves building


healthy, nurturing and supportive relationships with others to foster a
genuine connection between you and your colleagues or those around you.

 Some of the strategies to enhance social wellness are to build good rapport
with others by a strong social support network, practise effective
communication skills with others, interact with people of other cultures,
backgrounds and beliefs, and value the principles of time management.

 Occupational wellness is pertaining to employment that provides personal


satisfaction and enrichment in oneÊs life.

 Some factors that may contribute to occupational wellness are choice of


profession, job satisfaction, career development and personal performance.

 Environmental wellness is one of the important dimensions in health and


wellness. It focuses on the awareness of the individual, the community and
the society to prevent environmental hazards.

 Some strategies that can be implemented to promote environmental wellness


are the recycling campaign to educate and protect us against environmental
hazards, and developing an appreciation of nature, and respecting it and all
species living among nature.

 Financial wellness is a relatively new dimension and was generally adopted


as the eighth dimension in the aftermath of the great recession of December
2007 to June 2008. It can be defined as a state, level or quality of a personÊs
financial position or wealth.

Environmental wellness Occupational wellness


Financial education and wellness Personal satisfaction and enrichment
programmes
Recycling
Financial wellness
Social wellness

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62  TOPIC 3 DIMENSIONS OF HEALTH AND WELLNESS II

Hettler, B. (1976). The six dimensions of wellness. Retrieved from


http://www.nationalwellness.org/?page=Six_Dimensions

Hoeger, W. K., & Hoeger, S. S. (2003). Lifetime physical fitness and wellness,
a personalized program (7th ed.). Belmont, CA: Thomson Wadsworth.

LiveLifeWell.co. (2015). Financial wellness. Retrieved from


http://livelifewell.co/category/wellness/wellness_financial/wellness_fina
ncial.php

National Bureau of Economic Research (NBER). (2014). Economic report of the


president. Retrieved from
http://www.nber.org/erp/2014_economic_report_of_the_president.pdf

Payne, W. A., Hahn, D. B., & Mauer, E. B. (2005). Understanding your health (8th
ed). New York, NY: McGraw-Hill.

Petiprin, A. (2015). Nightingale environment theory. Retrieved at


http://www.nursing-theory.org/theories-and-models/nightingale-
environment-theory.php

World Health Organization (WHO). (1994). Global strategy on occupational


health for all: The way to health at work. Retrieved from
http://www.who.int/occupational_health/publications/globstrategy/en/

Copyright © Open University Malaysia (OUM)


Topic  Understanding
4 Nutrition and
Diet
LEARNING OUTCOMES
By the end of this topic, you should be able to:
1. Identify the components of healthy diet;
2. Distinguish the dietary challenges for special groups;
3. Compare healthy diet versus therapeutic diet; and
4. Plan for healthy diet.

 INTRODUCTION
Let us begin our lesson in this fourth topic by looking at these quotes (refer to
Figures 4.1 and 4.2).

Figure 4.1: Hippocrates (from 460BC to 370BC) ă Greek physician of the Age of Pericles
Source: www.azquotes.com

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64  TOPIC 4 UNDERSTANDING NUTRITION AND DIET

Figure 4.2: Terri Guillemets (1973) ă quotation anthologist


Source: www.vebidoo.com

Have you ever heard of all these quotes? Do you understand their meanings?
How does medicine relate to food? Can our bodies really run on fresh green fuel?
Imagine how this really happens in life! IsnÊt that interesting? These quotes are
related to healthy diet and healthy food intake to improve our lives
tremendously.

This topic will enhance your understanding of nutrition and diet. In addition,
there are a few related activities that can assist you to gain a better understanding
of this topic. As a working adult, it is very important for you to understand the
basic information about nutrition and diet so that you benefit from the
knowledge gained.

Do you agree that food is a source of pleasure? This is what some people say.
There are many reasons why people eat the way they do and it is true that food is
much more than a tool of survival. Food can be a source of comfort, a symbol of
hospitality and also an indicator of social status. For whatever reason, remember
that food also can be the source of our sickness. So, how do we prevent ourselves
from getting sick because of our food?

Food is generally good but it can also get you into trouble. So, how do we stay
healthy? Well, first of all you need to ask yourself „Am I eating right?‰ Next is
awareness. By increasing your awareness of healthy eating, you can prevent
yourself from getting sick. Most people are aware of the role of nutrition in
health and they want to eat better for health purposes but fail to translate their
desire into proper action.

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TOPIC 4 UNDERSTANDING NUTRITION AND DIET  65

Poor eating habits span all age groups. Healthy eating is a growing factor of
concern in many countries due to the increase in cases of overweight and obesity,
not only in Malaysia but worldwide. Modern lifestyles such as eating late and
young generations relying on fast food have led to eating disorders.

The Ministry of Health Malaysia has implemented various policies and


campaigns to promote healthier eating behaviour among the public. Some of the
campaigns are Healthy Lifestyle Campaign, Reduce Sugar Intake Campaign and
Guidelines on the Implementation of Healthy Eating in the Public Sector which
have been launched at national level. A revised version of Malaysian Dietary
Guidelines (MDG) was launched in 2010, comprising 14 messages and 55
recommendations to a healthy diet. The objectives of this guideline are to
promote healthy eating, regular exercise and effective use of nutrition
information on food labels (Tee, 2011). You can have your own copy of this
guideline at http://goo.gl/eUrivj.

In order to eat right or plan your diet, you need to know the components of a
healthy diet. Therefore, this topic will teach you how to do this and then, you
will be able to choose your right diet according to your body requirements.
Remember: to stay and maintain a healthy lifestyle, you need to exercise too!

4.1 COMPONENTS OF HEALTHY DIET


What do you understand about the components of a healthy diet? Do you think
that by eating a tuna sandwich with some cucumber in it and drinking a glass of
fresh milk, you will get proper components for a healthy diet? What are the
important nutrients contained in those foods? Let us check the contents based on
the food pyramid that dieticians always recommend for a healthy diet (refer to
Figure 4.3).

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66  TOPIC 4 UNDERSTANDING NUTRITION AND DIET

Figure 4.3: Food pyramid


Source: www.healthworks.my

Based on Figure 4.3, can you identify the contents in these foods? Generally, our
body requires proteins, fats, carbohydrates, vitamins, minerals and water which
can be found in the food we eat. These are called essential nutrients, which mean
you must get these substances from the food you eat because your body is not
able to manufacture them at all.

Now let us look at these nutrients further in the next subtopics.

4.1.1 Proteins
Did you know that proteins are the basics of our body structure? Proteins form
an important part of the bodyÊs main structural components (muscles and bones)
and also form important parts of blood, enzymes, some hormones and cell
membranes (Insel & Roth, 2008).

What are proteins composed of? Proteins are composed of chains of amino acids.
Amino acids are the „brick‰ from which the body constructs its own protein. In
our body, we use 20 amino acids in various combinations to build the protein
required for physiological processes so that we can continue to be healthy
(Williams, Anderson & Rawson, 2013).

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TOPIC 4 UNDERSTANDING NUTRITION AND DIET  67

The maintenance of body tissue is essential because the body is constantly


undergoing wear and tear, so proteins and amino acids provide continuous
repairs. What does wear and tear mean? Wear and tear mean that everyday our
tissues and cells die and will be replaced with new ones.

In addition, proteins act as a shield too. They will defend the body against
various diseases. When the body detects any invading antigens, they will
manufacture antibodies and giant protein molecules designed specifically to
combat the antigens.

Where can we get the proteins? What kind of diet contains proteins? Proteins in
the human diet come from the following two main sources:

(a) Animal proteins (such as egg, milk, meat and fish); and
(b) Plant proteins (such as cereals, nuts, beans and soy products).

ACTIVITY 4.1

Form small groups during your tutorial and discuss the importance of
proteins in the diet, according to age groups.

4.1.2 Carbohydrates
You have learnt that protein makes up the basic structure of the body. How
about carbohydrates? What is the role of carbohydrates in our body? Well, let us
look at its definition first.

Carbohydrate is a combination of sugar units and the major energy source


for the body.

In fact, each gram of carbohydrate contains four calories. Carbohydrates occur in


three forms ă monosaccharide, disaccharide and polysaccharide. I am sure you
are familiar with glucose. Did you know that glucose is one of the most
important monosaccharide? It makes up the blood sugar used as the bodyÊs
primary source of energy. In addition, it is the sole source of energy for the brain
and nervous system.

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68  TOPIC 4 UNDERSTANDING NUTRITION AND DIET

What will happen if the brain and nervous system do not have adequate energy?
Lack of glucose can result in weakness, dizziness and low blood glucose
(hypoglycaemia). Reduced blood glucose during exercise decreases performance
and could lead to mental as well as physical fatigue. All the cells and tissues in
our body need carbohydrates. Furthermore, they are also important for intestinal
health and waste elimination. In fact, carbohydrates are easily converted to fuel
once they entered our body.

There are two types of carbohydrates, which are simple and complex. Simple
carbohydrates (also called simple sugars) include sugars found in fruits,
vegetables and milk, as well as sugars added during food processing.

How about complex carbohydrates? Complex carbohydrates (also called


starches) include whole-grain breads and cereals, starchy vegetables and
legumes. Most complex carbohydrates contain fibre which helps digestive health
and increases satiety (feeling full), reducing overeating and weight gain. In
addition, high-fibre foods help lower cholesterol and decrease the risk of heart
disease.

Now let us look at the functions of carbohydrates. What are they? Do you have
any idea? Let us look at Table 4.1 for the answers.

Table 4.1: Functions of Carbohydrates

Function Description

Provide energy Carbohydrates are like a fuel source in our body. When you eat
foods that contain carbohydrates, your body will break them down
into glucose for better absorption.

Spare protein It is used for energy due to the lack of carbohydrates.

Maintain Fibre is one carbohydrate that is necessary for digestive health. The
digestive health main function is to help prevent constipation and diarrhoea and
also helps you feel full longer, which helps you avoid overeating.

Stimulate growth Carbohydrates that ferment in your intestines will stimulate the
of bacteria in growth of bacteria. This bacteria helps to break down food so that it
intestines can be used by the body. Some bacteria protect the colon from
harmful cells such as cancer. The foods that stimulate this type of
bacteria are known as prebiotics. Prebiotics are very important for
intestines health and you may want to consume it in tablet or liquid
form. For example, yogurt drinks such as Yakult or Vitagen.

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TOPIC 4 UNDERSTANDING NUTRITION AND DIET  69

ACTIVITY 4.2

Think of one recipe for your lunch to ensure you get enough portions of
carbohydrates. Discuss with your course mates during tutorial and
share your findings.

4.1.3 Fats
Now let us turn our attention to fats. Did you know that fats are also known as
lipids? The fats stored in our body represent usable energy, they help insulate
our body, and they support and cushion our organs. Fats in the diet help our
body to absorb fat-soluble vitamins (A, D, E and K) as well as add important
flavour and texture to foods. In addition, fats are the major fuel for the body
during rest and light activities.

There are two types of fats ă linoleic acid and alpha-linolenic acid. They are
essential components of our diet. They are used to make compounds that are key
regulators of body functions such as the maintenance of blood pressure and the
progress of healthy pregnancy.

The functions of fats are further explained in Table 4.2.

Table 4.2: Functions of Fats in the Body

Function Description

Energy Carbohydrates are the main source of fuel in our body. Sometimes
our body system turns to fat as a backup energy source when
carbohydrates are not available.

Vitamins Some types of vitamins rely on fat for absorption and storage.
absorption Vitamins A, D, E and K (called fat-soluble vitamins) cannot
function without adequate daily fat intake. These vitamins are
essential parts of your daily diet. Absorption of these vitamins may
be compromised without proper diet.

Insulation Fat cells, stored in adipose tissue, insulate your body and help to
sustain normal body temperature. Adipose tissue is not always
visible, but if you are overweight, you may be able to see it under
your skin. Stored fats surround vital organs to keep them protected
from sudden movements or outside impacts.

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70  TOPIC 4 UNDERSTANDING NUTRITION AND DIET

Did you realise that most of the fats that we eat are „hidden‰ in food? This is
because they have been incorporated during the preparation or cooking method
such as frying.

Every type of dietary fat is made up of a combination of three fats ă saturated,


monounsaturated and polyunsaturated, based on the chemical composition.
Take note that we are not going to learn about the details of these forms of fats
but as consumers, we need to pay attention to the amount of each type in our diet
because of their role in heart disease.

Furthermore, different types of fats have different effects on health especially


cholesterol level and risk of heart disease. Saturated and trans fatty acids raise
the blood level of low-density lipoprotein (LDL). This is the bad cholesterol that
enhances risk of heart problems. Monounsaturated fatty acids can be found in
olive or canola oils. This type of fatty acid can increase high-density lipoproteins
(HDL) which is also known as good cholesterol. Can you identify which fats are
good and which are not? Let us look at Figure 4.4 for an answer.

Figure 4.4: Good and bad fats


Source: https://blogs.otago.ac.nz

Saturated fats have been found to impair the ability of HDLs to prevent
inflammation of blood vessels and reduce their ability to react normally to stress,
thus reducing the risk of heart disease. So it is important for us to choose
unsaturated fats instead of trans or saturated fats.

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TOPIC 4 UNDERSTANDING NUTRITION AND DIET  71

How do we reduce both saturated and trans fat in our diet? The best way is to
lower your intake of meat and full-fat dairy products (whole milk, cream, butter,
yogurt and ice-cream). How about trans fats? Do you like to eat French fries? If
you do, please reconsider because deep-fried food, crackers, cookies and baked
goods contain trans fat which is not so good for your health.

ACTIVITY 4.3

Discuss the relationship between good and bad fats and how these fats
can lead to heart disease. Then, suggest ways to prevent it.

4.1.4 Vitamins
What do you understand about vitamins? We have heard about all types of
vitamins but how far do we understand the importance of vitamins in our diet?
Should we take supplements to ensure we have adequate vitamins? These are the
questions people always ask when they plan to buy additional vitamins. Now, let
us look at the details of vitamins. Firstly, its definition.

Vitamins are organic compounds required in small amounts for normal


growth, reproduction and maintenance of health.

Take note that vitamins do not serve as calories but serve as coenzymes. By
facilitating the actions of enzymes, vitamins help initiate a variety of body
responses including energy production, use of minerals and growth of healthy
tissues.

As human beings, we need 13 types of vitamins; four are fat-soluble (A, D, E


and K) and nine are water-soluble (C and the 8 B-complex vitamins such as
thiamin, riboflavin, niacin, vitamin B-6, folate, vitamin B-12, biotin and
pantothenic acid). Water-soluble vitamins are absorbed directly into the
bloodstream (Insel & Roth, 2008).

Vitamins are important to unleash energy stored in carbohydrates, proteins and


fats. They are critical in the production of red blood cells and the maintenance of
the nervous, skeletal and immune systems. Some of them act as antioxidants
which help preserve healthy cells in the body.

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72  TOPIC 4 UNDERSTANDING NUTRITION AND DIET

Where can we easily get vitamins? Forget about the bottled ones in the
pharmacies! Let us look at the natural sources. Vitamins are abundant in fruits,
vegetables and grains. In fact, our skin makes vitamin D when exposed to
sunlight and our intestinal bacteria make vitamin K.

What will happen if you donÊt get enough vitamins? Vitamins deficiency will
lead to a lot of problems. For example, vitamin A deficiency can cause blindness
and vitamin B6 deficiency can cause seizures. But remember! If you consume
extra vitamins, it will cause you harm too! For example, high doses of vitamin A
are toxic and increase risk of birth defects while excessive intakes of vitamin B6
can lead to irreversible nerve damage.

Let us look at Table 4.3 which shows you the water-soluble vitamins and their
functions. You might want to remember these functions to ensure you get
adequate dose.

Table 4.3: Water-Soluble Vitamins and Their Functions

Vitamin Function

B1 (thiamin)  Releases energy from carbohydrates.

B2 (riboflavin)  Releases energy from protein, fat and carbohydrate.


 Promotes healthy skin and eyes.

B3 (niacin)  Releases energy from protein, fat and carbohydrate.


 Involved in cholesterol production.

B5 (pantothenic  Releases energy from carbohydrate, fat and protein.


acid)

B6 (pyridoxine)  Breaks down protein.


 Helps to make red blood cells.

B12  Helps to make red blood cells, nerve cells and genetic material
(cyanocobalamin) (DNA).
 Breaks down carbohydrate and fat.

Folate (folic acid)  Helps to make red blood cells and enzymes and prevents neural
tube defects.
 Breaks down DNA material and reduces levels of homocysteine
(high levels are a risk factor for cardiovascular disease).

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TOPIC 4 UNDERSTANDING NUTRITION AND DIET  73

Biotin  Breaks down fat and protein.


 Promotes growth and healthy nerve cells.

C (ascorbic acid)  Forms collagen (an essential component of the skin, blood
vessels, bone and teeth).
 Acts as an antioxidant, providing resistance to infections and
promoting wound healing.
 Improves non-harm iron absorption.

Source: Carruthers (2006)

Table 4.4 explains fat-soluble vitamins and their functions.

Table 4.4: Fat-Soluble Vitamins and Their Functions

Vitamin Function

Vitamin A  Maintains healthy skin and eyes, improving vision at night and
(retinol) in dim light.
 Acts as an antioxidant, having a role in cancer prevention.

Vitamin D  Promotes strong bones and teeth.


(cholecalciferol)

Vitamin E  Maintains healthy cell membranes.


(tocopherols)
 Acts as an antioxidant.

Vitamin K  Needed for blood clotting.


(phylloquinone)

Source: Carruthers (2006)

ACTIVITY 4.4

Do you think that by exposing yourself to direct sunlight, you can get
enough vitamin D? Discuss the pros and cons of this method with your
tutor.

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74  TOPIC 4 UNDERSTANDING NUTRITION AND DIET

4.1.5 Minerals
Why do we need minerals? Minerals are important elements to regulate body
functions, aid in the growth and maintenance of body tissues, and help release
energy. They are also critical in the regulation of a number of body processes,
including fluid balance, nerve impulses, muscle contraction, heart function,
blood clotting, protein synthesis and red blood cell synthesis.

For your information, there are about 17 essential minerals that your body needs
including calcium, phosphorus, magnesium, sodium, potassium and chloride.

Essential minerals are divided into major minerals (macro minerals) and trace
minerals (micro minerals). These two groups of minerals are equally important,
but trace minerals are needed in smaller amounts than major minerals. Examples
of macro minerals are calcium, phosphorus, sodium, potassium and magnesium
whereas micro minerals consist of zinc, iron, copper, selenium and iodine.

Can you name some examples of food that contain the minerals? Examples of
food that contain minerals are lean meats (rich in iron), dairy products (excellent
source of calcium). Green leafy vegetables, white and sweet potatoes, banana and
other fruits contain potassium.

SELF-CHECK 4.1

Name all the nutrients that we need to stay healthy and give three
examples for each.

4.1.6 Water
I am sure you are aware that water is the major component in our body and in
foods. Generally, people can die if they do not have water for certain periods due
to dehydration. Our body is made up of 50 to 60% water. Water forms the basis
of blood, digestive juices, urine and perspiration, and is contained in lean muscle,
fat and bones.

Why do we need water? Our body needs water to regulate body temperature;
water plays a key role in nearly all of the bodyÊs biochemical reactions. However,
most people never seriously think about the importance of water for their body.
In fact, many of us obtain fluids from fruits or vegetables rather than drink it
straight.

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Here are some interesting facts about water for you to know (Better Health
Channel, 2015):

(a) Body water content is higher in men than in women and falls in both with
age;

(b) Most mature adults lose about 2.5 to 3 litres of water per day. Water loss
may increase in hot weather and with prolonged exercise;

(c) Elderly people lose about two litres per day;

(d) An air traveller can lose approximately 1.5 litres of water during a three-
hour flight; and

(e) Water loss needs to be replaced.

What are the risks if we do not drink enough water? Inadequate water intake can
increase the risk of kidney stones and urinary tract infection, especially in
women! It can also lower our physical and mental performance and lead to
dehydration. How do you know when your body needs water? A small amount
of dark-coloured urine can be the indicator that you are not consuming enough
water! Do you know what the solution is? Drink a lot of water (recommended
eight glasses per day) as clear or pale coloured urine is the indicator for enough
fluids in your body.

4.1.7 Dietary Challenges for Special Groups


Let us now discuss about dietary challenges for special groups of people. Who
are those categorised as special groups? They are children and teenagers, college
students, older adults, athletes and pregnant women.

Generally, people from different age groups will need different types of food. For
example, young people need to consume a variety of foods. Children and
teenagers, often need encouragement to eat vegetables and fruits. This group
usually loves to take fast food that contain more sodium and preservatives than
healthy fresh foods. The best thing a parent can do is to provide children with a
variety of foods.

College students always choose to consume unhealthy food because of their daily
activities. Some colleges provide dining hall or food court that does not offer
food that is high in nutrients or low in fat. They also love to grab fast food meals
because of their busy schedules.

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76  TOPIC 4 UNDERSTANDING NUTRITION AND DIET

Take note that nutrients are not changing so much as people age, but older adults
tend to become less active and they require fewer calories to maintain body
weight. Because of the age-related changes in digestive tract, their body also have
problems with the absorption of nutrients. Thus, they need to consume nutrient-
dense food in order to meet their body nutritional requirement.

Becoming an elite athlete requires good genes, good training and conditioning,
and not forgetting, a sensible diet. Optimal nutrition is essential for peak
performance. The most important aspects for athletes are to increase their energy
requirement and make sure they take enough fluids during their training to
remain hydrated.

Here are some guidelines for athletes:

(a) Athletes can achieve peak performance by frequent training and eating a
balanced diet that includes a variety of foods;

(b) Carbohydrates and fat can provide fuel for their body;

(c) The use of fat as a fuel source depends on the intensity and duration of the
exercise, and the athleteÊs condition;

(d) Exercise will increase the athleteÊs need for protein; and

(e) Water is a very critical nutrient for all athletes. Without enough intake of
water, dehydration may occur and cause muscle cramps and fatigue.
Furthermore, these conditions will increase the risk of heat stroke.

In order for you to understand the types of diet, further discussion in the next
subtopic will enable you to see the differences between healthy and therapeutic
diets. Let us continue our lesson!

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TOPIC 4 UNDERSTANDING NUTRITION AND DIET  77

ACTIVITY 4.5

1. Discuss with your tutor the appropriate diet for 6-year-old boys
and girls. Provide an appropriate diet that these children should
take.
2. Form two groups and debate these statements:
(a) Every time you eat or drink, you are either feeding disease
or fighting it.
(b) Do not eat less, eat right.

4.2 HEALTHY VERSUS THERAPEUTIC DIET


Before we end our lesson on nutrition and diet, let us discuss the issues between
healthy diet and therapeutic diet. It is hoped that by the end of this subtopic, you
will be able to differentiate between healthy diet and therapeutic diet.

4.2.1 Healthy Diet


Did you realise that healthy eating is not about strict dietary limitations, staying
unrealistically thin, or depriving yourself of the foods you love? Actually, it is
more about feeling great, having more energy, improving your outlook and
stabilising your mood. All of us know that eating right can help you maintain a
healthy weight and avoid certain health problems. But what happens if your diet
has a profound effect on your mood and sense of well-being? That is why if you
want to stay healthy, you need to take a healthy diet.

Eating more fruits and vegetables, cooking meals at home, and reducing your fat
and sugar intake, on the other hand, will help to improve mood and lower your
risk for mental health problems. If you have already been diagnosed with a
mental health problem, eating well may even help you to manage your
symptoms and regain control of your life. This shows the power of food.

How do we ensure we follow a healthy diet? You do not need to be perfect and
completely eliminate foods you enjoy to have a healthy diet that will make a
difference to the way you think and feel.

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78  TOPIC 4 UNDERSTANDING NUTRITION AND DIET

Here are some tips for planning a healthy diet (Robinson, Segal & Segal, 2015):

(a) Easy Tips for Success

(i) Prepare your own meals: Cooking meals at home will help you take
charge of what you are eating. You can monitor exactly what goes into
your food.

(ii) Make the right changes: Choose healthy foods only for your diet.

(iii) Simplify: Count your calories; think of your diet in terms of colour,
variety and freshness. Avoid packaged and processed foods and opt
for more fresh ingredients.

(iv) Read the labels: Be aware of what is in your food such as hidden
amounts of sugar and salt in packaged food.

(v) Your feelings after eating: This will help to foster healthy new habits
and tastes. The more healthy food you eat, the better you will feel
after a meal. Do not eat junk food as it causes more harm than good.

(b) Drink Plenty of Water

(i) Water can help in flushing our systems of waste products and toxins.

(ii) You may get dehydrated if you do not drink enough water and the
symptoms are tiredness, low energy and headaches.

(c) Moderation is the Key for Success

(i) It means eating when you are hungry.

(ii) You should feel satisfied after eating, but not stuffed.

(iii) Get a balanced diet: Protein, fat, fibre, vitamins and minerals to
sustain a healthy body.

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TOPIC 4 UNDERSTANDING NUTRITION AND DIET  79

(d) Fill Up on Colourful Fruits and Vegetables

(i) Fruits and vegetables are low in calories and nutrient dense. Focus on
eating the recommended daily minimum of five servings of fruits and
vegetables.

(ii) Try to eat a variety of colourful fruits and vegetables every day as
deeply coloured fruits and vegetables contain higher concentrations of
vitamins, minerals and antioxidants. You may add berries to breakfast
cereals, fruit for dessert and snack on vegetables such as carrots, snow
peas or cherry tomatoes instead of processed snack foods.

(e) Eat More Healthy Carbohydrates and Whole Grains

(i) Healthy carbohydrates (or good carbohydrates) include whole grains,


beans, fruits and vegetables. Healthy carbohydrates are digested
slowly, helping you feel full longer, and keeping your blood sugar
and insulin levels stable.

(ii) Unhealthy carbohydrates (or bad carbohydrates) are foods such as


white flour, refined sugar and white rice that have been stripped of all
bran, fibre and nutrients. They digest quickly and can cause spikes in
blood sugar levels and energy.

(f) Reduce Sugar and Salt

(i) Sugar not only creates weight problems but it also causes energy
spikes. In addition, it has been linked to diabetes, depression and
increase in suicidal behaviours for some people.

(ii) That is why we need to reduce the amount of candy and desserts that
we eat. However, it is only part of the solution as sugar is also hidden
in foods such as bread, cereals, canned soups and vegetables, pasta
sauce, margarine, instant mashed potatoes, frozen dinners, low-fat
meals, fast food and ketchup.

(iii) Sodium is another ingredient that is frequently added to food to


improve taste. However, our body actually does not need much
sodium in our daily intake.

(iv) Taking too much salt can cause high blood pressure and lead to an
increased risk of stroke, heart disease, kidney disease, memory loss
and erectile dysfunction.

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80  TOPIC 4 UNDERSTANDING NUTRITION AND DIET

4.2.2 Therapeutic Diet


Now we move on to therapeutic diet. What is therapeutic diet?

A therapeutic diet is a meal plan that controls the intake of certain foods or
nutrients.

It is part of the treatment of a medical condition and is normally prescribed by a


physician and planned by a dietician. A therapeutic diet is usually a modification
of a regular diet; it is modified or tailored to fit the nutrition needs of a particular
person (IHSS Training Academy, n.d.).

For this module, the discussion on therapeutic diet will focus on diabetes, high
blood pressure and renal diet only. You can get more information on other
diseases from textbooks or the Internet. Why do we just focus on these three
major diseases? This is because these diseases are very common nowadays and
they can affect the public at any age.

(a) Therapeutic Diet for Diabetes


First of all, what is diabetes?

Diabetes is a chronic disorder characterised by high blood glucose and


either insufficient or ineffective insulin; depending on the type of
diabetes.

What is the function of insulin? The function of insulin is to help in


maintaining blood glucose within normal limits and stimulates protein
synthesis, glycogen synthesis in liver and muscle as well as fat synthesis
(Whitney & Rolfes, 2002).

So, what is a diabetes diet? In the medical field, it is also known as medical
nutrition therapy (MNT) for diabetic patients. It is about eating a variety of
nutritious foods in moderate amounts and following regular mealtimes. It
is not a restrictive diet but MNT is a healthy-eating plan that is naturally
rich in nutrients and low in fat and calories. In fact, this diet emphasises
fruits, vegetables and whole grains; it is the best eating plan for everyone to
stay healthy.

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TOPIC 4 UNDERSTANDING NUTRITION AND DIET  81

What are the recommended foods for diabetes patients? Recommended


foods for diabetes patients are as follows:

(i) Healthy carbohydrates: Patients can take fruits, vegetables, whole


grains and low-fat dairy products for simple carbohydrates.

(ii) Fibre-rich foods: They are important to reduce risk of heart disease
and help in controlling blood sugar control. For examples, vegetables,
fruits, beans, nuts, whole-wheat flour and wheat bran.

(iii) Fish: Patients can eat fish at least twice a week. Fish can be a good
alternative to high-fat meats. For example, cod, tuna and halibut have
less total fat, saturated fat and cholesterol than meat and poultry. Fish
such as salmon, mackerel, tuna and sardines are rich in omega-3 fatty
acids, which can promote heart health by lowering blood fats called
triglycerides.

(iv) ‰Good‰ fats: Most fats are high in calories. However, foods that
contain monounsaturated and polyunsaturated fats like avocados,
almonds, pecans, walnuts, olives, canola oil, olive oil and peanut oil
can help lower your cholesterol levels.

Take note that diabetes can increase your risk of heart disease and stroke by
accelerating the development of clogged and hardened arteries. The
following are foods that you need to avoid if you have diabetes:

(i) Saturated fats: High-fat dairy products and animal proteins such as
beef, hot dogs, sausage and bacon contain a lot of saturated fats. You
should limit these foods to ensure you can stay healthy.

(ii) Trans fats: These fats are found in processed snacks, baked goods,
shortening and stick margarines, and should be avoided completely.

(iii) Cholesterol: Sources of cholesterol include high-fat dairy products


and high-fat animal proteins, egg yolks, shellfish, liver and other
organ meats. That is why you should limit your intake.

(iv) Sodium: Aim for less than 2,300mg of sodium a day. High sodium is
highly not recommended as it can increase your risk for high blood
pressure and other diseases.

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82  TOPIC 4 UNDERSTANDING NUTRITION AND DIET

(b) Therapeutic Diet for High Blood Pressure (HBP)


Now let us look at HBP. High blood pressure or hypertension, is a disease.
Even though it typically has no symptoms, HBP can have deadly health
consequences if not treated accordingly. Eating a heart-healthy diet is very
important for managing your blood pressure and reducing risk of heart
attack, heart disease, stroke and other diseases.

American Heart Association has suggested using Dietary Approaches to


Stop Hypertension (DASH) diet (it is a lifelong diet approach to healthy
eating habit that encourages or helps in preventing high blood pressure).
The DASH diet encourages you to reduce the sodium in your diet and eat a
variety of foods rich in nutrients that help lower blood pressure such as
potassium, calcium and magnesium (Mayo Clinic, 2015).

What does DASH diet consist of? What to eat according to this diet? To stay
healthy, you need to follow the recommended diet to prevent diseases
(refer to Table 4.5).

Table 4.5: Food to Consume to Prevent Diseases

Food Description

Grains  Six to eight servings a day.


 Bread, cereal, rice and pasta.

Vegetables  Four to five servings a day.


 Tomatoes, carrots, broccoli, sweet potatoes, greens and other
vegetables are full of fibre, vitamins and such minerals like
potassium and magnesium.

Fruits  Four to five servings a day.

Dairy  Two to three servings a day.


 Milk, yogurt, cheese and other dairy products are major sources
of calcium, vitamin D and protein.
 Choose dairy products that are low-fat.

Lean meat,  Six or fewer servings a day.


poultry and
 Meat can be a rich source of protein, vitamin B, iron and zinc.
fish

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TOPIC 4 UNDERSTANDING NUTRITION AND DIET  83

Nuts, seeds and  Four to five servings a week.


legumes
 Almonds, sunflower seeds, kidney beans, peas, lentils and other
foods in this family are good sources of magnesium, potassium
and protein.

Fats and oils  Two to three servings a day.


 Fat helps your body absorb essential vitamins and helps your
body's immune system.
 However, too much fat can increase your risk of heart disease,
diabetes and obesity.

Sweets  Five or fewer sweets a week.


 When you eat sweets, choose those that are fat-free or low-fat
such as sorbets, fruit ices, jelly beans, hard candy or low-fat
cookies.

Source: Mayo Clinic (2013)

Here is an important thing to remember: Drinking too much alcohol can


increase blood pressure. The DASH diet recommends that men limit
alcohol to two or fewer drinks a day and women one or less. However, the
DASH diet does not address caffeine consumption. The influence of
caffeine on blood pressure remains unclear. But caffeine can cause your
blood pressure to rise at least temporarily.

(c) Therapeutic Diet for Renal Problem


If you had been diagnosed with renal problem like chronic kidney disease,
you may need to alter your diet. These changes include:

(i) Limiting fluids.


(ii) Eating a low-protein diet.
(iii) Limiting salt, potassium, phosphorous and other electrolytes.
(iv) Getting enough calories if you are losing weight.

This diet is to keep the levels of electrolytes, minerals and fluid in your
body balanced especially when you have chronic kidney disease or are on
dialysis. People on dialysis need to follow this special diet to limit the
build-up of waste products in the body. Limiting fluids between dialysis
treatments is very important because most people on dialysis urinate very
little due to the malfunction of their kidneys. Without urination, fluid will

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84  TOPIC 4 UNDERSTANDING NUTRITION AND DIET

build up in the body and cause too much fluid in the heart, lungs and
ankles and could cause other complications.

SELF-CHECK 4.2

Differentiate between healthy diet and therapeutic diet.

ACTIVITY 4.6

1. Recommend an appropriate diet for high blood pressure patients.

2. Plan a proper diet for diabetic patients.

3. Discuss the advantages of organic food compared to normal food.

4. Explain the potential benefits of genetically modified foods to


society.

 Food is much more than a tool of survival.

 Components of healthy diet are protein, carbohydrates, fat, vitamins,


minerals and water.

 People of different age groups will need different types of food. Special
population groups include children and teenagers, college students, older
adults, athletes and pregnant women.

 Healthy eating is about feeling great, having more energy, improving your
outlook and stabilising your mood.

 A therapeutic diet is a meal plan that controls the intake of certain foods or
nutrients.

 A therapeutic diet is a modification of a regular diet. It is modified or tailored


to fit the nutritional needs of individuals.

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TOPIC 4 UNDERSTANDING NUTRITION AND DIET  85

 Diabetes is a chronic disorder characterised by high blood glucose and either


insufficient or ineffective insulin and depending on the type of diabetes.

 American Heart Association has suggested using DASH diet as it is a lifelong


diet approach to healthy eating habit that encourages or helps in preventing
high blood pressure.

 It is important to keep the levels of electrolytes, minerals and fluid in your


body balanced when you have chronic kidney disease or are on dialysis.

Amino acids High-density lipoproteins (HDL)


Antioxidants Lipids
Carbohydrates Low-density lipoprotein (LDL)
Coenzymes Minerals
Diabetes Protein
Dietary challenges Renal problem
Fats Therapeutic diet
Glucose Vitamins
Healthy diet Water
High blood pressure (HBP)

Better Health Channel. (2015). Water: A vital nutrient. Retrieved from


http://www.betterhealth.vic.gov.au/bhcv2/bhcpdf.nsf/ByPDF/Water_a_
vital_nutrient/$File/Water_a_vital_nutrient.pdf

Blakely, T. (2013). A fat week: Debates about saturated fat that will not go away.
Retrieved from http://blogs.otago.ac.nz/pubhealthexpert/2013/10/29/a-
fat-week-debates-about-saturated-fat-that-will-not-go-away/

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86  TOPIC 4 UNDERSTANDING NUTRITION AND DIET

Carruthers, F. (2006). The facts about vitamins and minerals. Retrieved from
http://www.healthyfood.co.nz/articles/2006/december/the-facts-about-
vitamins-and-minerals

IHSS Training Academy. (n.d.). Types of therapeutic diets. Retrieved from


http://www.cdss.ca.gov/agedblinddisabled/res/VPTC2/9%20Food%20N
utrition%20and%20Preparation/Types_of_Therapeutic_Diets.pdf

Insel, P. M., & Roth, W. T. (2008). Core concepts in health (10th ed.). Boston, MA:
McGraw-Hill.

Mayo Clinic. (2013). DASH diet: Healthy eating to lower your blood pressure.
Retrieved from http://www.mayoclinic.org/healthy-lifestyle/nutrition-
and-healthy-eating/in-depth/dash-diet/art-20048456

Mayo Clinic. (2015). Sample menus for the DASH diet. Retrieved from
http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-
eating/in-depth/dash-diet/art-20047110?pg=1

National Coordinating Committee on Food and Nutrition, Ministry of Health


Malaysia. (2010). Malaysian dietary guidelines. Retrieved from
http://dg.cnsoc.org/upload/affix/20140818104029708.pdf

Robinson, L., Segal, J., & Segal, R. (2015). Healthy eating. Retrieved from
http://www.helpguide.org/articles/healthy-eating/healthy-eating.htm

Whitney, E. N., & Rolfes, S. R. (2002). Understanding nutrition (9th ed.). Victoria,
Australia: Wadsworth Thomson Learning.

Williams, M. H., Anderson, D. E., & Rawson, E. S. (2013). Nutrition for health,
fitness and sport (10th ed.). New York, NY: McGraw-Hill.

Copyright © Open University Malaysia (OUM)


Topic  Maintaining
5 Weight
LEARNING OUTCOMES
By the end of this topic, you should be able to:
1. Explain the concept of weight management;
2. Identify the causes of obesity;
3. Differentiate the two types of eating disorders; and
4. Plan weight management techniques.

 INTRODUCTION
Are you happy with your weight? Do you weigh yourself every morning and feel
dissatisfied? How do you feel when you look at the scale? Hopefully, you do not
hurt the scale, unlike the cartoon in Figure 5.1!

Figure 5.1: „Occupational hazard‰ for scale


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88  TOPIC 5 MAINTAINING WEIGHT

Do you agree that most people think they should weigh more or less than they
do? Why do they think this way? Well, the primary reason for this is usually
their appearance! Our appearances have a very strong link to our weight. For
instance, the size of your clothing. Just think of your clothing size when you were
20. Is it the same as your current size? If the answer is no, then there are two
possibilities, either that you have sized down or sized up. If you have sized
down, yeay! Hurray for you! But if you have sized up, then you need to ponder
on your diet and physical activities.

Most of us have our own image or perception of how we would like to look,
particularly if it concerns our body weight. Sometimes we need to change the
way we look to ensure we achieve the image that we intend to have. Changes
may be needed to achieve an ideal body weight especially to attain a new
appearance. OneÊs physical appearance may improve oneÊs self-esteem.

Therefore, in this topic, we will be discussing a few aspects related to


maintaining weight. We are sure you agree that losing weight is not an easy task.
If you fail to maintain your ideal weight, you will regain the lost weight. In order
to ensure you understand the concept of weight maintenance, we will look at the
basic components of weight management. Enjoy your lessons!

5.1 BASIC CONCEPTS OF WEIGHT


MANAGEMENT
This first subtopic discusses two basic concepts of weight management. It is
hoped that by the end of this subtopic, you can discuss weight management with
your family and friends.

The two basic concepts of weight management are body mass index (BMI) and
body composition. How do we differentiate them? Let us find out the answers in
the following subtopics.

5.1.1 Body Mass Index (BMI)


What is body mass index (BMI)? What does it stand for?

Body mass index is a simple index of weight-for-height that is commonly


used to classify underweight, overweight and obesity in adults.
WHO (2015)

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TOPIC 5 MAINTAINING WEIGHT  89

How do we calculate BMI? It is calculated using the formula of a personÊs weight


in kilograms divided by the square of his or her height in meters (kg/m2) (WHO,
2015). Figure 5.2 shows you the formula to calculate BMI.

Figure 5.2: How to calculate body mass index (BMI)


Source: http://www.the-health-magazine.com

Nowadays, there are a lot of computer applications and websites that can perform
the calculation for you. You can try one at this website http://goo.gl/zURa85.

Take note that calculating BMI for children and teens is more complex than for
adults as it includes both gender and age (Insel & Roth, 2008). Did you know that
BMI is used as a screening tool to identify weight problems in children? The
Centers for Disease Control and Prevention (CDC) (2015) has developed BMI age
growth charts for girls and boys which can be consulted to provide a percentile
for a childÊs or teenÊs gender and age (Williams, Anderson & Rawson, 2013). This
is shown in Figure 5.3.

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90  TOPIC 5 MAINTAINING WEIGHT

Figure 5.3: BMI percentile for children and teens by


the Centers for Disease Control and Prevention
Source: http://nccd.cdc.gov

BMI does not reveal anything about body composition. Therefore, we need
another method to evaluate actual body composition. This will be explained in
the next subtopic.

5.1.2 Body Composition


What is body composition? Body composition is what makes up a human body.
The human body is divided into fat-free mass and body mass (fat). Fat-free mass
includes non-fat tissues like bone, muscle, water, connective tissue, organ tissues
and teeth while body fat includes fats that are incorporated in the nerves, brain,
heart, lungs, liver and mammary glands.

How do we calculate body composition? We can do this using a body


composition analysis.

Body composition analysis is a physical test that measures the proportion of


the various components of a personÊs body.

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TOPIC 5 MAINTAINING WEIGHT  91

In other words, it is an important procedure in determining your body fat


percentage. The most common form of body composition analysis is the BMI.
Body composition can be changed to improve the way you look and feel by
maintaining a healthy diet. However, we are not going to further explore the
details of body composition in this topic. If you need further information on it,
you can surf the Internet and read up on it.

But, keep in mind that the most important fact you should know are the factors
that contribute to excess body fat. Most of us claim that we follow a proper diet
but still gain weight. Why is that so? This is because of our body weight and
body compositions are determined by multiple factors that may vary from
individual to individual. Those factors can be grouped into genetic,
physiological, lifestyle and psychosocial.

These four factors are further explained in the following Table 5.1.

Table 5.1: Four Factors that Contribute to Excess Body Fat

Factor Description

Genetic Genes influence body size and shape, body fat distribution and
metabolic rate. The genes that you inherit from your parents may
influence your body weight but the lifestyle you adopt can change
that! That is the fact that you need to remember.

Physiological These factors include metabolism, hormones, fat cells and


carbohydrates craving. Change in diet can change these factors from
bad to good.

Lifestyle Eating and physical activities influence our body weight. Majority of
overweight adults and children will admit they are overeating,
consume high-fat, high-sugar and high-calorie foods.

In addition, modern high technological conveniences such as remote


controls, elevators and escalators have reduced some of our daily
physical activities. To make things even worse, most of us have
sedentary lifestyles. These sedentary lifestyles have led to increased
body weight.

Psychosocial Food is a very powerful tool to overcome negative emotions and


stress. Some people try to distract themselves from their problems by
eating. In some cultures, food has been used as a symbol of love and
care. It has also become part of celebration in some culture.

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92  TOPIC 5 MAINTAINING WEIGHT

You can visit the listed websites for more explanation on these factors:

(a) Research Chair in Obesity at http://goo.gl/nqq9wz


(b) Harvard Health Publications at http://goo.gl/5gYwlJ

SELF-CHECK 5.1

Form a group of three or four people in your tutorial class and discuss
the factors that contribute to excess body fat.

5.2 OBESITY
Now let us look at obesity. It is hoped that by the end of this subtopic, you will
be able to identify the causes of obesity.

Did you realise that healthy eating is currently a growing concern in many
countries? This is due to the rise in overweight and obesity rates worldwide (see
Figure 5.4).

Figure 5.4: Overweight and obesity rates worldwide


Source: http://www.nbcnews.com

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TOPIC 5 MAINTAINING WEIGHT  93

Overweight and obesity has changed the way we view nutrition. Nutrition
transition is a term that refers to the change in diet structure, sedentary lifestyles
and rapid increase in obesity rate (Ismawati, Zainalabidin & Golnaz, 2014; Wan
Nazaimoon et al., 2011). Based on WHO report in 2010, Malaysia has been rated
as the sixth country with the highest obesity rate in Southeast Asia (Ministry of
Health Malaysia, 2010). Are we going to „keep‰ this record? Of course not! That
is why we need to have a healthy lifestyle.

What is overweight and obesity? World Health Organization (2015) defines a


BMI greater than or equal to 25 as overweight and a BMI greater than or equal to
30 as obesity. This is illustrated in Figure 5.5.

Figure 5.5: Body mass index (BMI) for overweight and obesity

Keep in mind that being obese or overweight is not about aesthetics, but more on
being at greater risk of health problems. Some of the health problems related to
weight issues are explained in Table 5.2.

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94  TOPIC 5 MAINTAINING WEIGHT

Table 5.2: Health Problems Related to Obesity

Health Problem Description

Heart diseases As your BMI increases, so does the risk for heart problems. This
problem happens when plaque builds up in your coronary
arteries or arteries that supply your heart muscles with blood and
reduces the blood flow to the heart muscle. Plaque that
accumulates on the inner walls of your arteries is made from
various substances that circulate in your blood. These include
calcium, fat, cholesterol, cellular waste, and fibrin, a material
involved in blood clotting. As plaque deposits grow, it results in a
condition called atherosclerosis. This condition causes the arteries
to narrow and harden.

If you are overweight, you may develop hypertension, diabetes


and atherosclerosis. These conditions will put you at high risk of
cardiovascular disease. Obesity can lead to a condition where
your heart may not be able to pump enough blood to meet your
bodyÊs needs.

High blood Blood pressure is the force of blood pushing against the walls of
pressure arteries. If the pressure rises for a long period of time, it can
damage our body in many ways. The chance is higher if you are
obese.

Stroke When you are overweight or obese, plaque can easily build in
arteries. If the area of plaque ruptures, blood clot might form and
this condition can cause blockage of blood and oxygen flow to the
brain. The risk of stroke is higher if your BMI is higher.

Diabetes (type 2) Diabetes in simple words means high level of glucose in our
blood. For type 2 diabetes, your bodyÊs cells fail to use insulin
properly. Overweight people are more likely to develop type 2
diabetes if they fail to reduce their weight.

You can visit this website for more information about health problems related to
obesity at http://goo.gl/T16QGR.

ACTIVITY 5.1

1. Discuss the barriers to healthy eating that lead to obesity among


Malaysians.

2. Highlight actions to solve the above issue.

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5.3 EATING DISORDERS


Let us turn our attention to eating disorders. We hope that by the end of this
subtopic, you will be able to differentiate the two types of eating disorders (see
Figure 5.6).

Firstly, let us look at the definition of eating disorder.

Eating disorders can be defined as serious conditions related to persistent


eating behaviours that negatively impact your health, emotions and ability to
function.

Figure 5.6: Two types of eating disorders

As shown in Figure 5.6, there are two extreme conditions of eating habits that
lead to eating disorder. First, someone who consumes too much food and loves
eating is at risk of obesity. This disorder is known as bulimia nervosa. Second,
someone who refuses to eat is at risk of an extreme condition known as anorexia
nervosa.

Teenagers and young women are those groups of people who mostly experience
eating disorders. Why are these eating disorders dangerous for our health?

We will look at each of these disorders closely in the next subtopic.

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96  TOPIC 5 MAINTAINING WEIGHT

5.3.1 Anorexia Nervosa


How do we define anorexia nervosa? Well, here is a definition for you to
understand the meaning of anorexia nervosa.

Anorexia nervosa is a complex disorder that has three important features,


namely, refusal to maintain ideal and healthy body, fear of gaining weight
and a distorted body image.

Figure 5.7 shows you how people with anorexia nervosa look like.

Figure 5.7: Images of people with anorexia nervosa


Source: www.freakingnews.com

You can visit this YouTube link for better understanding on this problem at
https://goo.gl/W2AycE.

For those suffering from anorexia nervosa, life becomes a relentless pursuit of
thinness; they are willing to go to extremes to lose weight, even though they are
already skinny. Anorexia is not about food or weight but is much more
complicated than that. A person who suffers from this condition can die if he or
she does not seek proper treatment. Fortunately, recovery is possible if they want
to change.

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There are two types of anorexia as stated in Table 5.3.

Table 5.3: Two Types of Anorexia Nervosa

Restricting Purging

 Weight loss is achieved by restricting  Weight loss is achieved by vomiting or


calories. using laxatives and diuretics.

 For example, following drastic diets,


fasting and exercising to excess.

Now let us talk about the characteristics of anorexia nervosa. What are they?
People with anorexia nervosa are typically introverted, emotionally reserved and
socially insecure. In addition, their sense of self-esteem may be tied up entirely in
their evaluation of their body shape and weight (Insel & Roth, 2008).

What are the health risks if you have anorexia nervosa? Well, health
consequences that can happen include the following:

(a) For women, they can stop menstruating because of extreme weight loss;
(b) Intolerance of cold temperature;
(c) Low blood pressure; and
(d) Low heart rate.

Did you know that when body fat is virtually gone and muscles are severely
wasted, our body will turn to its own organs in a desperate search for protein?
That is why this may be the primary cause of death for anorexia nervosa patients.
In addition, their desperation to look thin can be one of the reasons they commit
suicide.

So how do we overcome this problem? In order to ensure this serious illness is


treated according to the nature of the disease, you must know how to tackle it.
The first thing to do is to avert a medical crisis by ensuring adequate body
weight, then counter this with psychological counselling.

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98  TOPIC 5 MAINTAINING WEIGHT

5.3.2 Bulimia Nervosa


Now let us look at bulimia nervosa. Bulimia nervosa is also a serious, potentially
life-threatening eating disorder. People with bulimia may secretly binge, eating
large amounts of food and then purge, trying to get rid of the extra calories in an
unhealthy way. For example, someone with bulimia nervosa may force herself to
vomit or engage in excessive exercise (see Figure 5.8).

Figure 5.8: Vomiting food after eating is one of the characteristics of bulimia nervosa
Source: http://amarhealth.com/2015/09/20/bulimia-nothing-unusual-good-for-health/

Sometimes, people purge after eating only a small snack or a normal-size meal.
Have you heard of any famous celebrity who has this problem?

Bulimia can be categorised in two types as explained in Table 5.4.

Table 5.4: Two Types of Bulimia Nervosa

Purging Non-Purging

Regularly self-induce vomiting or misuse Use other methods to get rid of calories
laxatives, diuretics or enemas after bingeing. and prevent weight gain, such as fasting,
strict dieting or excessive exercise.

What do you think about the characteristics of a person with bulimia nervosa?
A bulimic person on a binge will consume a lot of food and this is usually
followed by purging, vomiting or using laxatives. They always appear to eat
normally but in real situation, they do not feel happy when surrounded by food.
A factor that may contribute to this problem is changes in life such as having a
new baby, losing a job or stress.

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TOPIC 5 MAINTAINING WEIGHT  99

What are the health risks of this eating disorder? One of the risks is tooth decay.
Tooth decay may develop because of the large consumption of sugar. In addition,
repeated vomiting or the use of laxatives in combination with deficient calorie
intake may damage liver and kidneys and can cause abnormal heart rhythm
(cardiac arrhythmia). There are a lot more health consequences of bulimia
nervosa which you can read more in any related websites. One example is from
this website at http://goo.gl/K8dBXX.

So how do we treat this disorder? A person suffering from bulimia nervosa needs
to stabilise the eating pattern and improve their coping skills. For medical
treatment, they need to get advice from qualified psychiatrists and nutritionists.

SELF-CHECK 5.2

Create a table that differentiates between anorexia nervosa and bulimia


nervosa. Use „Definition‰, „Characteristics‰, „Health Risks‰ and
„Treatment‰ as fields.

ACTIVITY 5.2
Imagine you are suffering from a eating disorder. What are the steps
that you may take when you realise that your life is worth more than
the problem you are having?

5.4 WEIGHT MANAGEMENT TECHNIQUES


Lastly, before we end this interesting topic, let us learn how to manage our
weight. It is hoped that by the end of this subtopic, you will be able to plan your
own weight management using appropriate techniques.

What can we do to gain an ideal weight? Exercise? Limit what we eat? I know
most of us would choose the second option but why do you need to suffer when
you can enjoy your food by planning your diet. Just keep in mind that you must
know how to ensure you get your ideal weight and stay healthy. In order to
ensure these targets are achieved, you must learn weight management
techniques.

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100  TOPIC 5 MAINTAINING WEIGHT

First of all, let us look at how we should adopt healthy lifestyles for successful
weight management.

(a) Diet and Eating Habits


Plan your diet and enjoy your food of choice. You can refer to any food
pyramid to make a choice (see Figure 5.9).

Figure 5.9: Food pyramid


Source: https://tiffanycodilla.wordpress.com/

Take note that you also need to pay attention to the total calorie in take and
portion size so as to adjust eating habit to suit your requirement.

(b) Physical Activity and Exercise


We are sure you agree that regular exercise is very important in weight
management. In order to get an ideal weight, you need to burn the calories
and keep the metabolism geared so that your body uses food for energy
instead of storing it as a fat. There are many activities that you can try such
as walking, gardening, housework, dancing or even Zumba. You can pick
and select your own choice of activities to burn your calories.

(c) Thinking and Emotions


Did you realise that these two aspects are very important in weight
management? This is because what goes in your head is the main influence
that can change your thinking about your lifestyle in order for you to gain
your ideal weight. Generally, most overweight people have low self-
esteem. So, to change, you need to change your mindset; negative thoughts
will stop you from making a start. Therefore, you need to think that you
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TOPIC 5 MAINTAINING WEIGHT  101

can do it as healthy lifestyle needs support from positive thinking, realistic


beliefs and set goals to achieve your ideal weight.

We here discussed some tips to ensure you are able to adopt proper techniques
for weight management. Now let us look at how body image is important to help
you feel good. The objective is to ensure that you are happy with your ideal
weight and able to get rid of negative thoughts if your weight increases.

What is the meaning of body image?

Body image consists of perceptions, images, thoughts, attitudes and


emotions of a person.

When you have an ideal body weight, immediately your image will change and
you will be happy with your appearance.

However, some of us have severe body image problems. This will cause
significant psychological distress. Adolescents and adults who have negative
body images are more likely to have restricted diet or other eating disorders.
Generally, women are more concerned or dissatisfied with their body (Insel &
Roth, 2008).

How can you avoid body image problems? The following are some tips for those
who plan to make changes:

(a) Focus on healthy diet and ensure you take proper exercise.

(b) Ensure you have good psychological health because your worth as a
human being is not based on your appearance.

(c) You can influence your body size and determine your own lifestyle. You
may want to accept your size.

(d) Value and have respect for others.

(e) Healthy eating habits is an important part of wellness.

(f) Do not judge yourself or others based on appearance. Body size is just one
characteristic; you need to keep in mind that being happy is more
important.

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102  TOPIC 5 MAINTAINING WEIGHT

ACTIVITY 5.3

1. Discuss your strategies for weight management. Your strategies


must include these components:
(a) Choice of food;
(b) Planning and serving; and
(c) Physical activities.

2. Let us say you have a friend suffering from a eating disorder.


What is your plan to help your friend regain confidence and start
a new chapter in his or her life?

 There are two important concepts in weight management, which are body
mass index and body composition.

 Body mass index is a simple index of weight-for-height which is commonly


used to classify overweight and obesity in adults. It is defined as a personÊs
weight in kilograms divided by the square of his or her height in meters
(kg/m2).

 Body composition refers to fat-free mass and body mass (fat). Our body is
divided into these two components. Fat-free mass includes non-fat tissues
like bone, muscle, water, connective tissue, organ tissues and teeth, while
body fat includes fats that incorporated in the nerves, brain, heart, lungs,
liver and mammary glands.

 There are four factors that contribute to excess body fat ă genetic,
physiological, lifestyle and psychosocial factors.

 Overweight happens when your BMI is greater than or equal to 25 and


obesity happens when your BMI is greater than or equal to 30.

 There are two types of eating disorders, namely, anorexia nervosa and
bulimia nervosa.

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TOPIC 5 MAINTAINING WEIGHT  103

 Anorexia nervosa is a complex disorder with the following three symptoms:

 Refusal to maintain ideal and healthy body;

 Fear of gaining weight; and

 Distorted body image.

 People with anorexia nervosa are typically introverted, emotionally reserved


and socially insecure.

 Bulimia nervosa is a serious, potentially life-threatening eating disorder.


People with bulimia may secretly binge, eating large amounts of food and
then purge, trying to get rid of the extra calories in an unhealthy way.

 Weight management technique requires a person to adopt healthy lifestyles


such as good eating habits, exercise and positive attitude.

Anorexia nervosa Fat-free mass


Body composition Obesity
Body image Overweight
Body mass Plaque
Body mass index (BMI) Sedentary lifestyles
Bulimia nervosa Weight management

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104  TOPIC 5 MAINTAINING WEIGHT

Centers for Disease Control and Prevention (CDC). (2015). Division of nutrition,
physical activity and obesity. Retrieved from
http://www.cdc.gov/healthyweight/assessing/bmi/index.html

Insel, P. M., & Roth, W. T. (2008). Core concepts in health (10th ed.). Boston, MA:
McGraw-Hill.

Ismawati, S., Zainalabidin, M., & Golnaz, R. (2014). Healthy eating: The
preventive factors among Malaysians. Journal of Economics, Business and
Management, 2(4), 257ă261.

Keyes, A. (2014). Infographic: Obesity skyrockets across the globe. Retrieved from
http://www.nbcnews.com/nightly-news/infographic-obesity-skyrockets-
across-globe-n116996

Minsitry of Health Malaysia. (2010). Kenyataan akhbar Menteri Kesihatan


Malaysia. Retrieved from
http://www.moh.gov.my/index.php/database_stores/store_view_page/
22/71

Wan Nazaimoon, W. M., Kamarul Imran, M., Amir Sharifuddin, M. K., Aziz
al-Safi, I., Ikram Shah, I., Khalid, A. K., Nor Azmi, K., ... Wan Mohamad,
W. B. (2011). Prevalence of overweight and obesity among adults
Malaysian: An update. Asia Pacific Journal of Clinical Nutrition, 20(1),
35ă41.

William, M. H., Anderson, D. E., & Rawson, E. S. (2013). Nutrition for health,
fitness and sport (10th ed.). New York, NY: McGraw-Hill.

World Health Organization (WHO). (2015). Obesity and overweight. Retrieved


from http://www.who.int/mediacentre/factsheets/fs311/en/

Copyright © Open University Malaysia (OUM)


Topic  Preventing
6 Diseases
LEARNING OUTCOMES
By the end of this topic, you should be able to:
1. Discuss the importance of disease prevention to promote health and
wellness;
2. Summarise the risk factors, signs and symptoms as well as prevention
of cardiovascular disease;
3. Elaborate on the types, risk factors, signs and symptoms as well as
prevention of cancer;
4. Discuss diabetes mellitus and its causes, classification, risk factors and
prevention;
5. Summarise the risk factors and prevention of osteoporosis; and
6. Describe kidney disease and its causes, signs and symptoms, risk
factors and prevention.

 INTRODUCTION
Let us start our lesson by looking at this famous quote:

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106  TOPIC 6 PREVENTING DISEASES

We are sure you are familiar with it. What does this quote imply? The implied
message here is that promoting good habits to maintain health is a better option
than seeking cure for an ailment. The implication of the message proposes that
people who practise healthy habits as a way of life have a higher chance to enjoy
freedom from disease as dependence on medications and treatments to maintain
wellness is not a healthy way of living.

Did you notice that presently, non-communicable diseases due to lifestyle


choices is emerging as significant forms of disease patterns? People who do not
practise healthy lifestyles will become more vulnerable to these diseases. Some
examples of such disease conditions include coronary heart diseases, cancer,
diabetes mellitus, osteoporosis and kidney disease. These five diseases are the
focus of this topic.

You will learn their definitions, risk factors, signs and symptoms as well as
preventions. It is hoped that by the end of this topic, you can design your
personal plan to improve your health and wellness as well as preventing these
diseases.

6.1 IMPORTANCE OF DISEASE PREVENTION


Why do we need to learn the importance of disease prevention? Well, we need to
learn about disease prevention as a means to promote health and wellness in
ourselves. Therefore, this subtopic will deliver the points for you to remember.

Did you know that since the beginning of the 20th century, life expectancy has
improved dramatically worldwide especially in developed countries? Now,
people are living longer with significantly improved quality of life and not
succumbing easily to debilitating diseases. In Malaysia, the average life
expectancy has risen dramatically in the last 50 years, from below 60 years
during the Independence era to an average of 75 years today (MOH, 2015).

The promotion of healthy lifestyles and prevention of diseases through lifestyle


changes has greatly contributed in raising the health standards in this country.
Empowering people with appropriate knowledge and skills to modify their
lifestyles and to take active roles to prevent illnesses has become a compelling
inducement for those who understand the benefits of staying healthy.

In addition, most people now prefer to take an active role in decisions related to
their health matters as they dread the prospect of being hooked to a lifetime of
medications to cope with chronic illnesses.

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TOPIC 6 PREVENTING DISEASES  107

Furthermore, increasing awareness on the role of clean environment on health


and wellness is also becoming a major concern among many people as they begin
to realise the direct impact the environment has on their health. As a result, there
is a rising trend among health conscious individuals to play more active roles in
creating a clean and healthy environment that is conducive to general wellness.

The United Nations (UN) and the World Health Organization (WHO) work
closely with member countries to promote health and wellness of the
community. The promotion of healthy behaviours by health authorities has
effectively reduced the burden of preventable diseases and promoted better
quality of life and sense of well-being among the population.

For example, some of the deadly diseases like small pox and poliomyelitis is said
to be totally eradicated now. With the effective control of dreaded infections and
communicable diseases especially in countries with modern healthcare systems,
chronic and non-communicable diseases due to lifestyle choices is now emerging
as significant forms of disease patterns.

As stated before, the rise in non-communicable diseases is attributed to lifestyle


choices of people. People who do not practice healthy lifestyles will become more
vulnerable to such non-communicable diseases which have long term effects on
our body and are much more difficult to control. Did you know that most forms
of non-communicable disease are also known as chronic disease? What are the
examples of these conditions? Some examples of such disease conditions include
coronary heart diseases (CHD), cancer, diabetes mellitus, osteoporosis and
kidney disease. Coronary heart disease (CHD) is also known as coronary artery
disease (CAD).

You will learn more on these five diseases in the next subtopics. Hopefully you
can understand that many of these diseases can be controlled and even
prevented through lifestyle modifications. Let us now focus on some of the
serious but common diseases prevalent in this country.

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108  TOPIC 6 PREVENTING DISEASES

ACTIVITY 6.1

1. Differentiate between communicable diseases and non-


communicable diseases.

2. Look up Health Facts 2014 published by the Malaysian Health


Ministry at http://goo.gl/5mmFjx. Identify four examples of
communicable diseases and five examples of non-communicable
diseases.

3. Briefly state the lifestyle habits that relate to the cause of each of
the diseases you have identified in Question 2.

6.2 CARDIOVASCULAR DISEASES


This subtopic focuses on cardiovascular diseases. Hopefully, you will be able to
identify the common forms of heart disease that are linked to lifestyle choices
upon completing this lesson. Firstly, what does cardiovascular disease mean?

Cardiovascular diseases are a variety of ailments associated with


malfunctioning within the heart as well as the blood circulation in the body.

The most serious cardiovascular diseases that are related to lifestyle choices are
coronary heart diseases, heart failure, hypertension and stroke. There are some
heart conditions caused by other factors such as rheumatic heart disease and
valvular heart diseases due to infection and septal defects caused by congenital
anomalies.

6.2.1 Understanding the Heart


What can we say to define the heart?

The heart is a muscular organ about the size of your fist and is located at the
centre of the chest, behind the sternal bone.

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TOPIC 6 PREVENTING DISEASES  109

The following Figure 6.1 shows you the location and diagram of the heart.

Figure 6.1: Human heart

It is an amazing fact that our heart pumps approximately 70 times a minute in an


adult to circulate oxygenated blood to the cells of the body through a network of
arteries and receives back deoxygenated blood through the veins. The arteries
that supply oxygenated blood to the heartÊs own muscles are known as coronary
arteries.

Take note that there is a disease associated with coronary arteries. It is called
coronary heart disease (CHD) which accounts for the most number of fatalities
among cardiovascular diseases in adults. In other words, coronary artery disease
leads to coronary heart disease. Therefore, we will learn about this disease so that
you will be able to identify the common risk factors for coronary heart disease.

Coronary Heart Disease


What does CHD stand for?

Coronary heart disease is a condition where the heartÊs blood supply is


reduced or completely blocked by plaque which is formed due to build-up of
fats or other deposits such as tar from cigarettes within the walls of the
coronary arteries.

Did you know that the narrowing of the arteries due to the plaque is known as
atherosclerosis? Take note that as the size of the plaque gradually gets bigger, the
oxygenated blood supply reduces, causing damage to the cells of the heart
muscle. During this event, a person will eventually experience a heart attack that
manifests as chest pains. In medical terminology, a minor heart attack or
transient chest pains is known as angina pectoris, whereas a full-blown heart
attack is known as myocardial infarction.

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6.2.2 Risk Factors that Cause Coronary Heart Disease


(CHD)
What are the factors that trigger a heart attack? Heart attacks can be triggered by:

(a) Smoking;
(b) Diabetes mellitus;
(c) Hypertension;
(d) High blood cholesterol;
(e) Obesity; and
(f) Excessive and prolonged stress.

ACTIVITY 6.2

1. Identify the dangers of smoking to health.


2. Discuss the effects of obesity on your heart.

6.2.3 Seriousness of Coronary Heart Disease


Did you know that coronary heart disease is the main cause of death in
Malaysia? This is based on the statistics from Malaysian Health Ministry (MOH,
2015) which shows that CHD was the number one cause of death, amounting to
about 25% of all fatalities in hospitals in 2013.

In fact, coronary heart disease also happens to be among the top five reasons for
hospital admissions in Malaysia since the past decade. This trend is similar to
other developed and major developing countries.

For example, the Centres for Disease Control and Prevention (CDC) (2015)
reports that about 610,000 people die of heart disease in the US every year ă that
is one in every four deaths. As for the UK, about 1 in 6 men and 1 in 10 women
die of CHD annually. The astonishing facts are a grim reminder of the serious
threat that CHD poses on the health and wellness of people.

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ACTIVITY 6.3

1. Refer to Health Facts 2014 published by the Ministry of Health


Malaysia at https://goo.gl/qcdXV7. Identify the top five disease
conditions that were the cause of hospital admissions in this
country in 2013.

2. Discuss how many of the diseases are caused by lifestyle factors.

6.2.4 Signs and Symptoms of Coronary Heart Disease


What are the signs and symptoms of cardiovascular diseases? For coronary
artery disease, chest pain is the most common symptom experienced by a person.
As for coronary heart disease, the victim may also experience some of the
following signs and symptoms:

(a) Radiation of pain over left arm, neck, jaw, shoulder or stomach;
(b) Tightness over chest;
(c) Breathlessness;
(d) Heart palpitations;
(e) Excessive sweating;
(f) Feeling lightheaded or fainting; and
(g) Nausea.

Take note that not all victims of heart attacks experience the signs and symptoms
mentioned above as a person may even develop a silent heart attack during
sleep. Silent heart attacks are known to occur among people with diabetes.

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112  TOPIC 6 PREVENTING DISEASES

6.2.5 Preventing Coronary Heart Disease


How do we prevent CHD? This subtopic will provide the answers so that you are
aware of the ways to prevent and reduce coronary heart disease risks.

Lifestyle choices are linked to CHD. Some of the specific ways to prevent CHD
are as follows:

(a) Keeping blood pressure under control;


(b) Keeping blood sugar under control;
(c) Managing stress;
(d) Taking a healthy, well balanced diet;
(e) Being physically active and regular exercise;
(f) Maintaining a normal, healthy body weight;
(g) Refraining from smoking, recreational drugs and alcohol;
(h) Taking any prescribed medicines regularly; and
(i) Having a positive outlook in life.

SELF-CHECK 6.1

1. Define coronary heart disease (CHD).

2. List all the factors that lead to a heart attack.

3. Describe the signs and symptoms of coronary heart disease as well


as its prevention.

ACTIVITY 6.4

Discuss the effects of smoking on the risk of coronary heart disease.

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6.3 UNDERSTANDING CANCER


Now let us learn about cancer. It is hoped that by the end of this subtopic, you
would be able to appreciate that cancer is a disease condition that is linked to our
lifestyle choices.

Did you know that since the past 50 years, cancer has instilled great fear among
people? This is due to likelihood of it being a fatal disease with almost no
prospect of cure. In spite of major advances in medical science and technology,
the disease continues to afflict people of all ages, gender, ethnic origins and
socioeconomic status.

Previously, cancer used to be a worry among older age groups, but now
childhood cancers such as leukaemia and bone cancers are being reported with
increasing frequency. The Health Ministry of Malaysia (MOH, 2015) reported
4,414 deaths due to cancer in the year of 2013, ranking as the fourth principal
cause of death in hospitals of Malaysia.

6.3.1 What is Cancer?


Let us get to know the definition of cancer first. Do you have any idea?

Cancer is a condition where cells in a specific part of the body begin to grow
at an abnormal and uncontrollable rate.

This results in formation of tumours. What are tumours?

Tumours are abnormal masses of tissue cells that have grown and multiplied
rapidly.

These tumours can be benign or malignant. What are the differences between
them? Let us check out Table 6.1 for the answer.

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114  TOPIC 6 PREVENTING DISEASES

Table 6.1: Benign Tumours versus Malignant Tumours

Benign Tumours Malignant Tumours

Non-life threatening growths which are Grow rapidly and spread from the original
localised ă they do not spread to other primary site, to form new secondary
parts of the body. tumorous growths at other parts of the
body through a process called metastasis.
However, they can become large and
interfere with blood and lymphatic The cancer cells can infiltrate cells within
circulation or they may obstruct other their vicinity and destroy blood vessels,
body functions. organs, nerves and lymphatic system.

The severity of malignant tumours are


often classified by the level of
differentiation and advanced stage of cell
growth.

Let us look at Figure 6.2 which shows you the difference between benign
tumours and malignant tumours.

Figure 6.2: The difference between benign cells (not cancer) and malignant cells (cancer)
Source: www.medicinenet.com

SELF-CHECK 6.2

Describe the difference between benign tumours and malignant


tumours.

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TOPIC 6 PREVENTING DISEASES  115

6.3.2 Common Types of Cancer


Did you know that cancerous tumours are generally classified according to the
type of tissue from which they originate? There are mainly four types of cancer as
explained in Table 6.2.

Table 6.2: Four Types of Cancer

Type of Cancer Description


Carcinomas Originate in outer layers of body tissue called epithelial tissue.
Sarcomas Develop mainly in fibrous and connective tissue of body.
Lymphomas Develop and spread in the lymphatic system.
Leukaemia Affect leucocytes which are a form of blood cells in the body.

Apart from these four, cancers are also specified by the organ in which they
breed. Can you think of some examples? Well, the answers are lung cancer,
breast cancer, prostate cancer, bowel cancer, brain cancer and others. Keep in
mind that the diagnosis and treatments vary for each type of cancer.

6.3.3 Risk Factors for Cancer


This subtopic describes the common risk factors for cancer. It is hoped that by the
end of this subtopic, you can identify the common risk factors for cancer.
So, what are the risk factors for cancer?

Experts believe that the causes of most types of cancers are multifactorial.
Table 6.3 gives you the risk factors for cancer formation.
Table 6.3: Risk Factors for Cancer Formation

Risk Factor Description


Lifestyle Certain types of diet, smoking, stress and obesity can lead to cancer
choices formation.
Environmental Asbestos, tobacco, alcohol, radiation, carbon emissions, petroleum
exposure to by-products, toxic chemicals, certain dyes, food preservatives,
carcinogens ultraviolet light and others can contribute to cancer formation.
Viruses Herpes II, hepatitis B, HIV and Epstein Barr viruses are linked with
certain types of cancers.
Chronic Tobacco chewing leads to chronic irritation of the inner linings of the
irritation mouth.
Genetics Presence of oncogenes that predispose to cancer growths.

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6.3.4 Signs and Symptoms of Cancer


First of all, you need to be alert with your body. Take note of sudden,
unexplained changes to parts and normal processes of the body such as
appearance of lumps or blood in the urine or faeces; they should be investigated
for early signs of cancers. Other potential signs and symptoms of cancer include
the following:

(a) Sudden unexplained weight loss;


(b) Lumps in breasts or other body parts;
(c) Bleeding in between menstrual periods, blood in the urine, cough or
vomiting;
(d) Chronic cough, persistent, dull, aching pain over a body part, mild fever
and breathlessness;
(e) Changes in bowel habits such as blood in the stools, diarrhoea or
constipation for no apparent reason; and
(f) Moles that are growing more than seven millimetres in diameter, irregular
shape and size, itchy, crusting or bleeding.

SELF-CHECK 6.3

1. Briefly explain five risk factors for cancer formation.

2. Identify five abnormal changes in the body that may signal the
onset of cancer.

6.3.5 Prevention Strategies for Cancer


Before we end our discussion on cancer, let us learn its prevention so that you
can suggest approaches that we can take to prevent or reduce personal risks of
cancer.

What does prevention of cancer refer to? Prevention of cancer refers to


recognition of potential cancer causing hazards and taking affirmative action to
avoid prolonged exposure to carcinogens from the food source and other
environmental hazards. Some of the specific prevention strategies are explained
in Table 6.4.

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TOPIC 6 PREVENTING DISEASES  117

Table 6.4: Specific Prevention Strategies for Cancer

Strategy Description

Improving  Vigilant about risk factors such as regular screening if history of


lifestyle cancer present among blood-linked family members and avoidance
behaviours of over exposure to known pollutants as form of occupational
hazard.
 Avoidance of toxic chemical and radioactive radiation exposure.
 Protection against excessive exposure to ultra violet light.
 Eating a balanced and healthy diet.
 Avoidance of alcohol and tobacco.
 Controlling excessive body weight.
 Regular exercise.
 Managing stress.
 Regular checking of body parts to detect sudden, abnormal
changes, such as:
ă C : Change in bowel or bladder habits;
ă A : A sore that does not heal;
ă U : Unusual bleeding or fluid discharge from the body;
ă T : Thickening or lump in breasts or elsewhere;
ă I : Indigestion that persist or difficulty in swallowing;
ă O : Obvious change in a wart or mole; and
ă N : Nagging cough or voice hoarseness.

Practising  Although maintaining a healthy environment requires a collective


responsible effort within the larger community, a person can:
consumerism
ă Begin to exercise his or her right by observing good purchasing
habits;
ă Choose more „green‰ products;
ă Choose organic food products;
ă Avoid pollution; and
ă Participate in responsible recreation.

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Becoming an  Being aware of safer options when seeking for medical treatment;
active
advocate for  Awareness and avoidance of risk factors to yourself, family and
your health community;
 Spreading consciousness about role of responsible citizenship
within the community; and
 Exercising voting rights for governance of safe, healthy
environment and legislation of sound health policies.

6.4 UNDERSTANDING DIABETES MELLITUS


Now let us turn our attention to diabetes mellitus. I hope by reading this
subtopic, you will be able to increase your awareness of diabetes mellitus as it is
a chronic condition that is mainly linked to poor lifestyle choices.

Do you know anyone around you who has diabetes mellitus? Chances are that
you will easily recall someone you know who has diabetes mellitus. It has
become one of the fastest growing disease conditions afflicting humans in the
modern era.

Why is it considered to be a very serious disease condition? Diabetes mellitus is a


very serious disease condition as it leads to multiple body complications such as
atherosclerosis, coronary heart disease, hypertension, infections, cataracts,
blindness, chronic kidney disease, skin infections, gangrene and erectile
dysfunctions.

6.4.1 Causes of Diabetes Mellitus


Before we look at the causes of diabetes mellitus, let us look at its definition.

Typically, diabetes mellitus is an endocrine disorder perpetuated by


irregularity of insulin production or its physiologic action in the body.

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What does insulin mean?

Insulin is a hormone produced by the pancreas. Its function is to enable


glucose (from carbohydrates metabolism) in the blood stream to enter into
the body cells for energy production.

What happens if the insulin is insufficient? If there is insufficient insulin, glucose


levels remain high in the blood stream, giving rise to hyperglycaemia. Likewise,
reduced blood glucose levels or excessive levels of insulin in the blood stream
will cause hypoglycaemia. Figure 6.3 shows you the different signs and
symptoms for these two conditions of insufficient insulin.

Figure 6.3: Signs and symptoms of hyperglycaemia and hypoglycaemia


Source: http://positivemed.com/2012/12/23/blood-sugars-high-or-low/

SELF-CHECK 6.4

Identify the causes as well as signs and symptoms for hyperglycaemia


and hypoglycaemia.

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6.4.2 Classification of Diabetes Mellitus


Did you know that generally there are three types of diabetes mellitus? These are
further explained in Table 6.5.

Table 6.5: Three Types of Diabetes Mellitus

Types of Diabetes Mellitus Description


Type 1 diabetes mellitus This is also known as insulin-dependent, juvenile onset
diabetes.
Type 2 diabetes mellitus This is non-insulin dependent diabetes, typically adult
onset diabetes. It is the most common type of diabetes.
Gestational diabetes Apart from the two main types, this is a transient type
of diabetes which manifests in some women during the
pregnancy period and resolves when pregnancy is over.

In our ongoing discussion about diabetes mellitus, we will focus on type 2


diabetes as the risk of its onset is commonly linked to poor lifestyle practices.

SELF-CHECK 6.5

State the major difference between type 1 and type 2 diabetes mellitus.

6.4.3 Risk Factors of Diabetes Mellitus


By reading this subtopic, it is hoped that you will be able to identify the common
risk factors for diabetes mellitus. So, what are they?

The risk factors for diabetes mellitus stem from a mix of neglect of healthy
lifestyle choices and some elements of non-modifiable risk factors such as the
following:

(a) Obesity and physical inactivity;


(b) High fasting blood sugar levels;
(c) Advancing age;
(d) Genetic predisposition; and
(e) Ethnicity.

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From these five factors, we can observe that obesity, physical inactivity and high
blood sugar levels can be controlled and thus are classified under modifiable risk
factors. Conversely, we note that advancing age, genetic predisposition and
ethnicity are non-modifiable risk factors for diabetes mellitus.

ACTIVITY 6.5

Conduct an online search and prepare a brief explanation on how


obesity can lead to diabetes mellitus.

6.4.4 Prevention of Diabetes Mellitus


Lastly, how do we prevent diabetes mellitus? This subtopic provides you with
the answer so that you will be able to suggest approaches to prevent risk of this
disease.

As yet, diabetes is considered an incurable disease condition and medical


interventions merely attempt to regulate blood sugar levels by various means to
negate the effects of complications from diabetes to the body. Therefore,
prevention of diabetes is a better option as there is no known cure; it is prudent
to prevent diabetes from taking root. This can be done by recognition and control
of its trigger factors which are in the form of modifiable and non-modifiable risk
factors.

Vigilance and conscious efforts to mitigate the latent risk factors are essential for
the disease prevention. The following are important aspects of prevention in
order to prevent onset of diabetes mellitus:

(a) Maintaining ideal body weight;


(b) Engaging in a regular programme of aerobic fitness exercises;
(c) Maintaining a normal level of blood glucose; and
(d) Early recognition of the warning signs of diabetes.

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6.5 OSTEOPOROSIS
Now let us learn about osteoporosis. It is hoped that by reading this, you should
be able to link osteoporosis as a condition that is related to our lifestyle choices.
What do you know about osteoporosis? What can you say about it?

Osteoporosis is a condition in which the bones weaken and become fragile as


a result of low mineral content usually due to progressive aging.

Gradual loss of mineral content, mainly calcium phosphate renders the bones to
be at greater risk of fracture and delayed healing. Women are particularly at
higher risks for osteoporosis soon after their body stops estrogen production at
menopause. Figure 6.4 shows you how osteoporosis looks like.

Figure 6.4: Normal bone versus bone with osteoporosis


Source: http://scienceblogs.com

6.5.1 Risk Factors for Osteoporosis


What are the risk factors for this disease? Let us continue our lesson so that you
can identify the common risk factors for osteoporosis.

Osteoporosis results from a combination of factors such as:

(a) Genetics;
(b) Body frame size;
(c) Gender;

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TOPIC 6 PREVENTING DISEASES  123

(d) Race;
(e) Advancing age;
(f) Reduced peak bone mass;
(g) Low estrogen and testosterone levels;
(h) Physical inactivity;
(i) Inadequate dietary calcium intake;
(j) Smoking; and
(k) Alcohol consumption.

ACTIVITY 6.6

Conduct an online search on the typical lifestyle practices that increase


the risk of osteoporosis. Share your findings during tutorial.

6.5.2 Prevention Strategies for Osteoporosis


Hopefully by the end of this subtopic, you can suggest approaches that we can
take to prevent osteoporosis.

Take note that an important aspect of prevention includes making the right
lifestyle choices at the early stages to reduce the rate of bone mass loss in later
years. Some of the strategies include the following:

(a) Increased physical activity;


(b) Taking dietary calcium supplements as required;
(c) Being wary of over exercising;
(d) Controlling alcohol consumption; and
(e) Quit smoking.

ACTIVITY 6.7

Identify five examples of local food products that contain high calcium
content, suitable for people to avoid osteoporosis.

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6.6 KIDNEY DISEASE


Lastly, before we end this interesting topic, let us look at kidney disease. It is
hoped that by learning this subtopic, you can relate kidney disease as a disease
condition that is linked to our lifestyle choices.

Did you know that kidney disease have become the most common cause of
kidney failure that cause patients to undergo dialysis treatment, often for life?
Statistics released by MOH (2015) quote kidney diseases as the eighth most
common cause for hospital admissions in 2013, accounting for more than 5% of
all hospitalisations in Malaysia.

As human beings, we have a pair of kidneys in the abdominal cavity on either


side of the spine, just above the waist (refer to Figure 6.5).

Figure 6.5: Kidney position


Source: www.ehealthstar.com

What are the functions of kidneys? The kidneys perform several life-sustaining
functions such as:

(a) Cleansing the blood by removing waste and excess fluids;


(b) Maintaining the balance of salts and minerals in the blood;

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TOPIC 6 PREVENTING DISEASES  125

(c) Helping to regulate blood pressure;


(d) Producing a hormone named erythropoietin which stimulates red blood
cell production; and
(e) Producing a form of vitamin D which we need for bone health.

The sudden loss of kidney function is called acute kidney failure or acute kidney
injury. It is mainly attributed to the following three effects that disrupt the
functions of the kidneys:

(a) Lack of blood flow to the kidneys;


(b) Direct damage to the kidney tissue; and
(c) Blockage of urine flow from the kidneys.

Take note that kidney failure can be fatal, and requires urgent and intensive
treatment.

6.6.1 Common Causes of Kidney Disease


What are the common causes of kidney disease? Some of the common factors that
lead to kidney disease include:

(a) Traumatic injury to kidney tissue that leads to bleeding;


(b) Severe, prolonged dehydration;
(c) Damage to kidneys due to shock during severe sepsis;
(d) Obstruction of urine flow due to prostate enlargement, strictures or renal
calculi;
(e) Damage from certain nephrotoxic drugs or poisons; and
(f) Complications related to pregnancy such as eclampsia.

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6.6.2 Signs and Symptoms of Kidney Disease


Sometimes, failure of kidney function due to disease has a slow, insidious onset
and does not show any overt symptoms. It is detected incidentally through
routine laboratory tests done for other reasons. However, you can look at these
obvious physical signs and symptoms:

(a) Decreased urine output;


(b) Fluid retention causing swelling in the legs, ankle region and feet;
(c) Drowsiness;
(d) Shortness of breath;
(e) Chronic fatigue;
(f) Confusion;
(g) Nausea;
(h) Seizures or coma in severe cases; and
(i) Chest pain or pressure.

6.6.3 Risk Factors for Kidney Disease


Did you know that diabetes and high blood pressure are two leading causes of
kidney damage? This is because they cause insidious damage to the delicate
blood vessels within the kidneys. The other risk factors include:

(a) Cardiovascular diseases;


(b) Family history of kidney disease;
(c) Infections; and
(d) Nephrotoxic drugs and chemicals.

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6.6.4 Prevention of Kidney Disease


Lastly, let us learn how to prevent this disease so that you will be able to suggest
approaches that we can take to prevent risk of kidney disease.

As we have read in the earlier discussion, prevention strategies prove to be an


effective approach to avert the risk factors through lifestyle modifications to
control modifiable risk factors for kidney damage. Therefore, a person who is at
risk of kidney damage should adhere to the following precautions:

(a) Make healthy lifestyle a priority;

(b) Regular medical check-ups to screen for kidney damage;

(c) Manage diabetes, hypertension or heart disease;

(d) Take prescribed medicines regularly and accordingly on time;

(e) Keep kidneys healthy by choosing to eat foods that are free from toxic
chemicals, and increase the portion of fresh foods and green vegetables;

(f) Maintain adequate hydration of the body with clear fluids;

(g) Control salt, potassium-rich foods and sugar intake in the diet;

(h) Limit alcohol consumption;

(i) Be physically active;

(j) Keep weight at ideal levels;

(k) Keep cholesterol levels within normal range; and

(l) Quit smoking.

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ACTIVITY 6.8

Complete the following personal health risk assessment:

Type 2 Diabetes Risk Assessment


Circle the right answer and add up the points. Compare your final score with
the risk of developing diabetes mellitus.

Question Point Question Point


Age How often do you eat vegetables
or fresh fruits?
Less than 35 years 0 Everyday 0
35 to 44 years 1 Not everyday 1
45 to 54 years 2 Have you ever taken medication for
high blood pressure on regular basis?
55 to 64 years 3 No 0
Above 64 years 4 Yes 2
Body mass index (BMI) Have you ever been found to have
high blood glucose (such as in health
screening test, during illness)
Below 25kg/m2 0 No 0
25 to 30 kg/m2 1 Yes 5
Above 30 kg/m2 3 Have any of your immediate family
members or close relatives been
diagnosed with diabetes?
Waist circumference measured at level of No 0
belly button (navel)
For men Yes, grandparent, 3
aunty, uncle or 1st
cousin
Less than 94cm 0 Yes, parent, brother, 5
sister or own child
94 to 102cm 3 Total risk score
More than 102cm 4
For women Interpretation of personal
score
Less than 80cm 0 Lower than 7 Low risk to develop
diabetes
80 to 88cm 3 7 to 11 Slightly elevated
risk
More than 88cm 4 12 to 14 Moderate risk
15 to 20 High risk
Higher than 20 Very risk
Do you usually have at least 30 minutes
of vigorous physical activity or exercise
daily, excluding normal daily activities?
Yes 0
No 2

Source: http://www.diabetes.fi

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TOPIC 6 PREVENTING DISEASES  129

Advice to Lower Your Risk of Developing Type 2 Diabetes

You cannot do anything about your age or your genetic predisposition.


On the other hand, the rest of the factors predisposing to diabetes, such as
overweight, abdominal obesity, sedentary lifestyle, eating habits and
smoking, are up to you. Your lifestyle choices can completely prevent
type 2 diabetes or at least delay its onset until a much greater age.

If there is diabetes in your family, you should be careful not to put on


weight over the years. Growth of the waistline, in particular, increases the
risk of diabetes, whereas regular moderate physical activity will lower the
risk. You should also pay attention to your diet; take care to eat plenty of
fibre-rich cereal products and vegetables every day. Omit excess hard fat
from your diet and favour soft vegetable fats.

Early stages of type 2 diabetes seldom cause any symptoms. If you scored
12ă14 points in the risk assessment, you would be well advised to
seriously consider your physical activity and eating habits and pay
attention to your weight, to prevent yourself from developing diabetes.
Please contact a public-health nurse or your own doctor for further
guidance and tests.

If you scored 15 points or more in the risk assessment, you should have
your blood glucose measured (both fasting value and value after a dose of
glucose or a meal) to determine if you have diabetes without symptoms.

Source: http://www.diabetes.fi

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130  TOPIC 6 PREVENTING DISEASES

Assessing Your Risk for Osteoporosis


For each of the following questions, check either yes or no.

1. Do you have a family history of 2. Did you go through menopause or


osteoporosis? (Have any of your have your ovaries removed by
female relatives broken a wrist or surgery before age 50?
hip or had a dowagerÊs lump?)
Yes  No  Yes  No 
3. Did your menstrual periods ever 4. Did your ancestor come from
stop for more than a year for England, Ireland, Scotland,
reasons other than pregnancy or Northern Europe or Asia or do you
nursing? have a small, thin body frame?
Yes  No  Yes  No 
5. Have you had surgery in which a 6. Are you taking or have you taken
part of your stomach or intestines drugs like cortisone, steroids or
was removed? anticonvulsants over a prolonged
period?
Yes  No  Yes  No 
7. Do you have a thyroid or 8. Are you allergic to milk products or
parathyroid disorder are you lactose intolerant?
(hyperthyroidism or
hyperparathyroidism)?
Yes  No  Yes  No 
9. Do you smoke cigarettes? 10. Do you drink wine, beer or other
alcoholic beverages daily?
Yes  No  Yes  No 
11. Do you do less than one hour of 12. Have you ever exercised so
exercising such as aerobics, walking strenuously that you had irregular
or jogging per week? periods or no periods at all?
Yes  No  Yes  No 
13. Have you ever had an eating
disorder (bulimia or anorexia
nervosa)?
Yes  No 

How did you do?


Did you have several yes answers? If so, you may have a very high chance of
getting osteoporosis. It would be a good idea to talk with your doctor today so
that you can work together to keep this disabling disease from happening to
you.

Source: Donatelle, Snow & Wilcox (1999)

Based on your personal scores levels on each of the above scales, prepare
an action plan for healthy lifestyle activity for yourself.

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TOPIC 6 PREVENTING DISEASES  131

 The promotion of healthy lifestyles and prevention of diseases through


lifestyle changes has greatly contributed to improving the health standards of
people in this country.

 Empowering people with appropriate knowledge and skills to modify their


lifestyles and take active roles to prevent illnesses have become a compelling
inducement for those who understand the benefits of staying healthy.

 Most non-communicable diseases such as coronary heart diseases, cancer,


diabetes mellitus, osteoporosis and kidney disease are attributed to lifestyle
choices.

 People who do not practise healthy lifestyles will become more vulnerable to
non-communicable diseases which have long term effects on the body and
are difficult to control.

 Cardiovascular diseases consist of a variety of ailments associated with


malfunctioning within the heart as well as the blood circulation in the body.
The most serious cardiovascular diseases that are related to lifestyle choices
are coronary heart diseases, heart failure, hypertension and stroke.

 Common risk factors for coronary heart disease include smoking,


uncontrolled diabetes mellitus, uncontrolled hypertension, high blood
cholesterol, obesity, and excessive and prolonged stress.

 Chest pain is the most common symptom experienced by a person with


coronary artery disease. As for coronary heart disease, some of the signs and
symptoms are nausea, breathlessness, excessive sweating and others.

 Some of the ways risk of CHD can be mitigated are managing stress, keeping
blood sugar and blood pressure under control and many more.

 Cancer is a condition where cells in a specific part of the body begin to grow
at an abnormal and uncontrollable rate. They are four types of cancer namely
carcinomas, sarcomas, lymphomas and leukaemia.

 Common risk factors for cancer include poor lifestyle choices, environmental
exposure to carcinogens, exposure to viruses linked to certain types of
cancers, chronic irritation and genetic predisposition to cancer.

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132  TOPIC 6 PREVENTING DISEASES

 Some of the signs and symptoms of cancer are sudden unexplained weight
loss, lumps in breasts or other body parts, moles that grow more than seven
millimetres in diameter and others.

 General prevention of cancer refers to recognition of potential cancer causing


hazards and taking affirmative action to avoid prolonged exposure to
carcinogens from the food source and other environmental hazards.

 Diabetes mellitus is an endocrine disorder perpetuated by irregularity of


insulin production or its physiologic action in the body. It can be divided into
three types ă type 1, type 2 and gestational diabetes.

 Common risk factors for diabetes mellitus include obesity and physical
inactivity, high fasting blood sugar levels, advancing age, genetic
predisposition and ethnic predisposition.

 General prevention for diabetes mellitus is recognition and control of its


trigger factors which are in the form of modifiable and non-modifiable risk
factors. For example, maintaining ideal body weight and normal level of
blood glucose, exercise and early detection.

 Osteoporosis is a condition in which the bones weaken and become fragile as


a result of low mineral contents usually due to progressive aging.

 Common risk factors for osteoporosis include genetic predisposition, gender,


race, advancing age, reduced peak bone mass, low estrogen and testosterone
levels, physical inactivity, inadequate dietary calcium intake, smoking and
alcohol consumption.

 An important aspect of prevention of osteoporosis includes making the right


choice of lifestyle at early stages which can reduce the rate of bone mass loss
in later years. The right choice of lifestyle can be in terms of physical activity
increment, taking calcium supplements and quit smoking.

 Acute kidney failure results in the inability of the kidneys to filter the waste
matter in the blood, which leads to rapid deterioration in health of the victim.

 Common causes of kidney disease are traumatic injury to kidney tissue,


severe and prolonged dehydration, eclampsia during pregnancy and others.

 Some of the signs and symptoms of kidney disease are decreased urine
output, drowsiness, confusion, nausea, chronic fatigue and others.

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TOPIC 6 PREVENTING DISEASES  133

 Common risk factors for kidney disease include coexisting cardiovascular


diseases, family history of kidney disease, infections, exposure to nephrotoxic
drugs and chemicals.

 Some of the preventions for kidney disease are healthy lifestyles, regular
medical check-ups, be physically active, have an ideal weight, quit smoking
and others.

Acute kidney failure Leukaemia


Cancer Lymphomas
Carcinomas Non-communicable diseases
Coronary artery disease (CAD) Osteoporosis
Coronary heart disease (CHD) Preventions
Diabetes mellitus Risk factors
Disease prevention Sarcomas
Gestational diabetes Signs and symptoms
Healthy lifestyles Stroke
Heart failure Type 1 diabetes mellitus
Hypertension Type 2 diabetes mellitus
Ideal body weight

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134  TOPIC 6 PREVENTING DISEASES

Centres for Disease Control and Prevention (CDC). (2015). Heart disease facts.
Retrieved from http://www.cdc.gov/heartdisease/facts.htm

Donatelle, R., Snow, C., & Wilcox, A. (1999). Wellness: Choices for health and
fitness (2nd ed.). Belmont, CA: Wadsworth.

Finnish Diabetes Association. (2003). Programme for the prevention of type 2


diabetes in Finland. Retrieved from
http://www.diabetes.fi/files/1108/Programme_for_the_Prevention_of_
Type_2_Diabetes_in_Finland_2003-2010.pdf

Ministry of Health Malaysia (MOH). (2014). Health facts 2014. Retrieved from
https://goo.gl/qcdXV7

NHS Choices. (2013). Cancer information and useful links. Retrieved from
http://www.nhs.uk/conditions/Cancer/Pages/Introduction.aspx

NHS Choices. (2014). Osteoporosis. Retrieved from


http://www.nhs.uk/conditions/Osteoporosis/Pages/Introduction.aspx

Palevsky, P. M. (2015). Definition of acute kidney injury (acute renal failure).


Retrieved from http://www.uptodate.com/contents/definition-of-acute-
kidney-injury-acute-renal-failure

Pruss-Ustun, A., & Corvalan, C. (2006). Preventing disease through health


environment: Towards an estimate of the environmental burden of disease.
Geneva, Switzerland: WHO Press.

Copyright © Open University Malaysia (OUM)


Topic  Financial
7 Health and
Wellness
LEARNING OUTCOMES
By the end of this topic, you should be able to:
1. Differentiate between financial health and financial wellness;
2. Identify the challenges confronting „emerging‰ adults in their quest
for financial wellness;
3. Discuss the elements of financial wellness; and
4. Construct a financial fitness plan.

 INTRODUCTION
As discussed in the previous Topic 3, financial health and wellness is one of the
eight dimensions of the holistic model of health and wellness. Can you still
recall? Take note that each of the eight dimensions has to be pursued
individually but in tandem with the pursuit of the other seven dimensions.

What are you going to learn in this topic? Basically, this topic is organised into
four subtopics. In subtopic 7.1, we will be introduced to financial health and
financial wellness. It also discusses the importance of financial wellness in the
context of oneÊs total health.

Then in subtopic 7.2, we will discuss the challenges to the attainment of financial
wellness particularly during oneÊs passage to adulthood. Knowledge of past
challenges (which had been experienced by past generations) will enable one to
be better prepared to circumvent them as one travels through glitches in life.

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136  TOPIC 7 FINANCIAL HEALTH AND WELLNESS

This is followed by subtopic 7.3 which discusses the elements of financial


wellness that would be of help as one strives to attain wellness. Lastly, the final
subtopic concludes with the concept of financial fitness, which is in vogue among
major corporations around the world to help defray the cost of attainment of
health and wellness to the corporations and their respective constituents alike.
Hopefully, by the end of this topic, you will be able to construct a financial fitness
plan that suits you. All the best!

7.1 FINANCIAL HEALTH AND WELLNESS


This first subtopic explains financial health and financial wellness. Hopefully, by
the end of this subtopic, you will be able to differentiate between the two. Now,
let us look at the definition of financial health first. Do you have any idea what it
means?

Financial health is a term used to denote „the state of oneÊs personal financial
situation‰.

Take note that there are many dimensions of financial health, for example,
disposable income, savings and loan repayments. In addition, the concept is
embedded in the practices of organisations.

How do we determine the financial health of business organisations? Financial


health of business organisations is determined by examining their:

(a) Financial conditions (what the firm has) such as assets;

(b) Liabilities (what the firm owes); and

(c) Net worth (net amount of what the firm has after taking into consideration
the claim of lenders on what the firm has).

Apart from knowing the absolute amount of each item, it is also important to
know its relative composition. However, these items showed their respective
position at one point in time. Other important aspects to consider are dimensions
which show potential improvements or otherwise, of these items over time. This
dimension is essentially pictured by the profitability of the firm. This is because
profitability is an important determinant of the firmÊs future finances or its
wellness.

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TOPIC 7 FINANCIAL HEALTH AND WELLNESS  137

How about financial health of individuals? Similarly, it is a description of how


well one deals with his or her finances, like making timely payments and setting
aside a certain amount for savings.

Now let us move on to financial wellness. Financial wellness of individuals, on


the other hand, is a more holistic description. It denotes „the state of
psychological well-being in which one feels they have control over their
respective current finances as well as future finances.‰

Did you know that financial wellness is a new concept that came as an aftermath
of the global Great Recession of 2008 to 2009? The turmoil of the Great Recession
left many feeling vulnerable. Many people were ill-prepared to handle the
experience of personal financial crisis that ensued.

The two years of the Great Recession was not the only cause of the personal
financial crisis. The effect of the recession on individuals was compounded by
the widespread lack of appreciation of the basic underlying principles of good
personal finance practices. As a consequence, poor financial results were
experienced.

What are the impacts of the poor financial state? The impacts of the poor
financial state that resulted were compounded by widespread job losses,
declining asset values and great drops in value of savings. These adverse
phenomena left many in a state of financial distress. What does financial distress
mean?

Financial distress is a term in corporate finance which describes a situation


where a company fails to honour its promises to pay its creditors according
to the agreed term of credit.

What happens if financial distress cannot be relieved? If financial distress cannot


be relieved, it may lead to bankruptcy.

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138  TOPIC 7 FINANCIAL HEALTH AND WELLNESS

Consequentially, the concept of financial well-being came about as an important


dimension of health and wellness. Generally, financial wellness is a state of
financial affairs where an individual has achieved the following:

(a) Strong financial foundation with little or no debt, with some emergency
savings fund and surplus income over expenditure;

(b) An ongoing plan that puts one on track to reach future financial goals; and

(c) Absence of financial stress.

ACTIVITY 7.1

Go to University of Wisconsin-River FallsÊs website and take the


wellness assessment test at https://goo.gl/rPHR1s. Answer each
question honestly and reflect whether you could have been better off if
each of the said practice has been observed fully.

7.1.1 Importance of Financial Wellness in the Context


of One’s Total Health
Lien (2012), in introducing his Primal Finance Series, employed MaslowÊs
hierarchy of needs to illustrate the building block of personal financial fulfilment
and happiness. Following Maslow, Lien felt that it is hard for one to achieve
professional success if he or she is devoid of „a meaningful place to live in,
clothes to wear or food to consume. Fulfilling basic needs are mostly required
before trying to satisfy higher order desires.‰ Lien thus laid the basic foundation
of his series on MaslowÊs hierarchy of needs.

For our purpose, it makes sense to use it as building blocks for reaching personal
financial wellness. Let us review MaslowÊs hierarchy of needs shown in
Figure 7.1.

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TOPIC 7 FINANCIAL HEALTH AND WELLNESS  139

Figure 7.1: MaslowÊs hierarchy of needs


Source: https://jimlien.files.wordpress.com

MaslowÊs hierarchy of needs is a psychological model based on analysing human


needs and trying to fulfil them in a pecking order.

Overall, the pecking order of needs is described in Table 7.1; it starts from basic
to the most advanced.

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140  TOPIC 7 FINANCIAL HEALTH AND WELLNESS

Table 7.1: MaslowÊs Hierarchy of Needs

Level Type of Needs Specific Needs


1 Physiological Breathing, food, water, sex, sleep, homeostasis and
(most excretion. Not unsurprisingly, these are health related
basic issues. Why would you try to attain something higher
needs) than health if you have none to enjoy?

2 Safety The security of body, employment, resources, morality,


family, health and property. Much of these have to do
with externalities, primarily political. Most importantly,
is there a system of morality established in my place of
residence in which I feel safe in regards to myself and
my family? If I earn something, do I get to keep it? Are
there sufficient opportunities to earn a living to provide
for my family?

3 Love/belonging Humans are social creatures. Most of the very successful


people are connectors. They help people meet other
people who can then provide some sort of value in a
mutually beneficial way.

4 Esteem Self-respect, confidence, strength, mastery, independence


and freedom. Esteem ultimately comes from having good
relationships, practice and experience.

5 Self-actualisation This means reaching full potential. By using Maslow as


(most a model, you can determine where you should focus
advanced your first efforts in financial enlightenment; it is a good
needs) way to start.

Source: Lien (2012)

SELF-CHECK 7.1

Briefly describe MaslowÊs hierarchy of needs based on the five different


levels.

ACTIVITY 7.2

In small groups, discuss how you would explain the „financial


happiness‰ in the context of Maslow hierarchy of needs.

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7.2 CHALLENGES TO FINANCIAL WELLNESS


Now we come to look at the challenges to financial wellness. It is hoped that by
finding out more about these challenges, you can design plans which can help
you remove obstacles to lay the foundations for your financial wellness.

Let us reflect on this question: At what age do you think one is expected to be
financially independent? Well, one is expected to be financially independent as
one enters adulthood. This is because as a legal adult, he or she is a person who
has attained the age of majority and is therefore regarded as independent, self-
sufficient and responsible.

Did you know that adulthood can be identified by using a marker? The passage
from adolescence to adulthood is marked by the experience of particular life
events. So, what are they? Traditionally, the major markers have been identified
as these life events (see Figure 7.2).

Figure 7.2: Four experiences to mark adulthood

In the past, up to the era of baby boomers (born between 1946 and 1964), the
passage to adulthood had been rather smooth. The emerging adults would have
acquired the finesse of adulthood primarily through direct guidance and support
from parents.

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142  TOPIC 7 FINANCIAL HEALTH AND WELLNESS

7.2.1 Economic Challenges


The majority of Generation X-ers (born between 1965 and 1980) and boomers
believe Generation Y or Millennials (born after 1980) face more economic
challenges than they themselves had faced when they were first of age (Pew
Research Centre, 2014).

The more trying conditions faced by Millennials themselves have caused them to
be realistic about their relative positions. A research poll in 2014 revealed that
only 42% of the Millennials identify themselves as „middle class‰, whereas 53%
of their fellow Millennials in an earlier poll (which was in 2008) had claimed
themselves to be so. In fact, more strikingly, 46% of them described themselves as
of lower than middle class in the recent survey (Pew Research Centre, 2014).

7.2.2 Other Challenges


Do you realise that there are more major developmental changes and challenges
associated with the period of adolescence? For example, the millennial youths
have to acquire and consolidate their competencies, attitudes, values and social
capital necessary to make a successful transition into adulthood.

Late adolescence and the period that follows (often referred to as emerging
adulthood), have been noted as particularly important. It constitutes a stage for
continued development as individuals begin to make choices and engage in a
variety of activities that are potent influences for the rest of their lives.

Take note that as youth move into emerging adulthood, their choices and
challenges shift. This includes decisions related to the traditional markers of
adulthood as shown in Figure 7.2.

Recently, social scientists have found that the transition to adulthood is taking
longer to complete. This is because becoming an adult today (for Generation Y
and Millennials) is totally different from 30 years ago. This can be related to some
of the contributing factors which include the following (Richardson, 2015):

(a) New economic landscape;


(b) Changed perspectives; and
(c) An altered path to professionalism.

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TOPIC 7 FINANCIAL HEALTH AND WELLNESS  143

Nonetheless, the Millennials are almost as optimistic of their financial futures as


Generation Xers were when they were of comparable age. Those who were
employed then were confident that they were earning enough to live the life that
they aspired while those who were not employed were bullish about their
financial futures (Pew Research Centre, 2015).

Even though emerging adults who had not moved out realised that they were
pulling clear of their adolescent struggles and starting to feel responsible for
themselves, they still had to cling to the lifeline of their accommodative parents
(Munsey, 2006).

According to Munsey, Arnett (2000) thus proposed a new period in lifespan that
he called „emerging adulthood‰. This emerging adulthood has certain distinct
characteristics as described in the following Table 7.2.

Table 7.2: Five Characteristics of Emerging Adulthood

Characteristic Description
Age of identity Young people are deciding who they are and what they want out of
exploration work, school and love.

Age of The post-high school years are marked by repeated residence


instability changes. As young people, they either go to college, or live with
friends or a romantic partner. For most, frequent moves end as
families and careers are established in the 30s.

Age of self- Freed of the parent and society-directed routines of school, young
focus people try to decide what they want to do, where they want to go and
who they want to be with ă before those choices get limited by the
constraints of marriage, children and a career.

Age of feeling Many emerging adults say they are taking responsibility for
in between themselves, but still do not completely feel like an adult.

Age of Optimism reigns. Most emerging adults believe they have good
possibilities chances of living „better than their parents did‰ and even if their
parents separate, they believe they will find a lifelong soulmate.

Source: Arnett (2000)

According to Arnett (2000), emerging adults pin their hopes from life ă a job that
is well paid and personally meaningful, and a lasting bond with a partner.
However, Arnett is pessimistic ă many might be headed for disappointment.
Most employers simply want someone who can get a job done. If happiness is the
positive difference between what you actually get and what you expect out of
life, then a lot of emerging adults are setting themselves up for unhappiness
(Munsey, 2006).

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144  TOPIC 7 FINANCIAL HEALTH AND WELLNESS

7.2.3 Contributing Factors to Delayed Adulthood


What are the factors that contribute to delayed adulthood? Well, let us find the
answer in Figure 7.3.

Figure 7.3: The factors that contribute to delayed adulthood

These factors are further explained as follows:

(a) Economic Landscape


Have you ever worked in a factory during school break or semester break?
Most of you would say „yes‰. Am I right? In the past, even before
completing school, many teenagers could work in factories, earning enough
money to support themselves or family. The farsighted few would go to
college and enjoy the benefits of say, supervising the production lines.
However, over time, local openings became scarce as manufacturing
establishments flew to cheaper jurisdictions.

Aspiring school leavers soon realised they needed to scale up ă hence to


college. With time, it is commonly seen that one needed to pursue tertiary
education to make it. College attendance thus soared.

However, with college attendance, debt ensued. Add to it the rising costs of
living, food, accommodation and transportation. So, it is not a big surprise
that young people often do not settle into careers and family until after their
mid-twenties. The reason is that they simply do not have the money. The
dominating factor is that it is taking longer for young adults to transition into
adulthood. This transition period has been labelled as the „emerging
adulthood‰ by some or as „in-between age‰ by others (Richardson, 2015).

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TOPIC 7 FINANCIAL HEALTH AND WELLNESS  145

(b) Housing Issue


Did you notice that millions of young adults live with their parents? Do you
know why? In fact, some young adults have failed to grasp life bravely
while others just do not have the money to live independently.

(c) Unemployment and Underemployment


Did you know that nearly 75 million young people worldwide are
unemployed? In fact, the global youth unemployment rate has remained at
12.6% since 2009.

In Malaysia, the youth unemployment rate has remained high since the
Asian financial crisis of 1998. From a low of 6.7% in 1996, the youth
unemployment rate shot up to 11.3% in 2010.

Even graduate unemployment rate which did not exceed 2.3% in the early
1990s before the Asian financial crisis, has since not gone anywhere below
2.9%.

These figures have not yet taken into account the millions of young people
who are underemployed. In addition, the cost of living, housing, healthcare
and childcare are rising too, against the backdrop of increasing
unemployment and underemployment. Topping it up is the impending
shrinking of job opportunities among aspirants caused by higher retirement
age (Asia Pacific Youth Employment Network, 2012).

(d) New Approach to Relationships


The social and economic changes that contributed to the rise of emerging
adulthood include the transition from a manufacturing economy to an
economy based mainly on information, technology and services. This has
caused more and more young people to pursue longer post-secondary
education in order to prepare themselves for jobs in the new economy.

Therefore, this means later ages of entering marriage and parenthood, and
widespread acceptance (or at least tolerance) of premarital sex and
cohabitation following the invention of the birth control pills in the 1960s.

Remember, none of these changes is likely to be reversed in the expected


future. For this reason, it makes sense for us to see emerging adulthood as a
new life stage rather than as a generational shift that will soon shift again
(Richardson, 2015).

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146  TOPIC 7 FINANCIAL HEALTH AND WELLNESS

Take note that besides the four factors discussed just now, there are two other
factors that contributed to delayed adulthood too (refer to Figure 7.3). They are
described as follows:

(a) Destabilising Behaviours


These behaviours can be divided into two types:

(i) Vicarious Influence


Do you agree that young adults are more susceptible to the influence
of celebrities rather than their elders? In other words, they tend to
follow celebrities. As Boon and Lomore (2006) said „adolescents often
form strong attachments to figures they encounter in the popular
media.‰

Sports stars are also recognised as favourite celebrity role models for
many young individuals. Athlete role models are known to influence
adolescentsÊ behavioural intentions, especially with respect to relevant
products (see Figure 7.4).

Figure 7.4: Christiano Ronaldo for Nike advertisement


Source: http://www.nike.com

With respect to this, results of relevant research replicated locally


found that both direct and vicarious role models influence the
purchasing intentions and behaviour of Malaysian adolescents. In
fact, the findings suggest that vicarious role models play a more
influential role then the direct (parental) role models (Cyril de Run,
Butt & Chung, 2010).

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TOPIC 7 FINANCIAL HEALTH AND WELLNESS  147

Furthermore, the result seems to be at odds with the eastern values


and culture believed to be well entrenched among Malaysians.
Probably, it may be the effect of the following:

 Phenomenal economic growth that Malaysia enjoyed during the


last three decades; or

 Industrialisation and presumably westernisation of the Malaysian


society have somehow influenced the cultural values of emerging
adults.

(ii) Impulsive Buying


What does impulsive buying refer to? Impulsive buying refers to
purchases of goods and services that one had not planned to buy.
Traditionally, impulse buying occurs in stores as a result of display
strategies and personal selling strategies employed by retailers.

Let us reflect on the following two scenarios (refer to Table 7.3).

Table 7.3: Two Scenarios for Your Reflection

Scenario Description

Scenario Have you experienced buying candy and chocolates that you have never
A planned to buy? However, you simply bought them upon noticing them at
the cashier while you were about to pay for things that you had planned to
purchase (see Figure 7.5).

Figure 7.5: Checkout counter


Source: http://www.novograf.co.uk

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148  TOPIC 7 FINANCIAL HEALTH AND WELLNESS

Scenario Have you experienced buying things online and while you are doing so, your
B attention was directed to a display „customers who purchase what you are
purchasing also purchase these‰ (refer to Figure 7.6).

Figure 7.6: Online shopping strategy


Source: http://www.lazada.com.my

What can you conclude about these two scenarios? Well, for Scenario A,
retailers are emulating the display strategies and personal selling strategies
of „brick and mortar‰ retailers. As for Scenario B, beware of buying things
you have never planned to but impulsively did so because you have been
prompted.

(b) Potent Force


The last factor for our discussion is potent force. Did you realise that
Generation Y is also considered a potentially large labour force? In fact,
they are capable of forming a pattern of socio-economic development
among various generations of a pluralistic society. Furthermore, they live in
a world of technology and the Internet.

Therefore, they always want something challenging and do not wish to be


bored with the same daily routine. They have their own favourite social
activities and most of them live in a world where they can connect and
interact in a global borderless way (Alwi, Amir Hashim & Ali, 2015).
Currently, Generation Y dominate more than 50% of the workforce or about
21% of MalaysiaÊs 29 million population (PriceWaterhouseCoopers, 2015).

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TOPIC 7 FINANCIAL HEALTH AND WELLNESS  149

ACTIVITY 7.3

1. „Emerging adulthood is a new life stage in oneÊs life cycle.‰ What


do you think of this statement? Discuss the distinctive features of
this „new life stage‰ and their implications on individualsÊ strive
for financial wellness.

2. Read the following article and discuss in groups:

The Malaysian Insider (15 October 2015), Malaysia Gen Y in debt,


living on the edge, survey reveals at http://goo.gl/Sb6dd7

7.3 ELEMENTS OF FINANCIAL WELLNESS


Now let us move on to identify the elements of financial wellness. It is hoped that
by the end of this subtopic, you will be able to understand them better.

Firstly, look at this finding from Financial Finesse (2013) taken from Yahoo
Finance website.

62% of those surveyed who are under 30, report that they have „some‰
financial stress, and another 15% say that they have „high‰ or overwhelming
levels of financial stress.

How do we relate financial stress with financial wellness? Well, let us look at
financial wellness first. What does financial wellness mean? Simply put, financial
wellness may be defined as a state of being wherein a person can fully meet
current and ongoing financial obligations, feel secure about their financial future
and is able to make choices that allow him or her to harvest lifeÊs enjoyment.

In addition, financial wellness is based on a continuum ranging from severe


financial stress to being highly satisfied with oneÊs financial condition. Some
people may seem to have, and feel they have, a high level of financial wellness
even though they may seem far from affluent.

On the other hand, some who seem wealthy may not appear to have, or feel they
enjoy, a high level of financial well-being.

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150  TOPIC 7 FINANCIAL HEALTH AND WELLNESS

The goals and vision of a satisfying life differs greatly among individuals.
However, there are two common themes that come up consistently ă security
and freedom of choice whether in the present or in the future (Consumer
Financial Protection Bureau, 2015).

Now let us redirect our attention to the elements of financial wellness. There are
four elements of financial wellness as shown in Figure 7.7.

Figure 7.7: Four elements of financial wellness

These four elements are further described as follows:

(a) Having Control Over Day-to-Day, Month-to-Month Finances


Individuals who at of a relatively high level of financial well-being feel in
control of their day-to-day financial life. These individuals manage their
own finances are able to cover expenses and pay bills on time, and do not
worry about not having enough money to go by.

(b) Having the Capacity to Absorb a Financial Shock


Individuals who are at a relatively high level of financial well-being also
have the capacity to absorb a financial shock. They are able to cope with the
financial challenges of unforeseen life events.

(c) Being on Track to Meet Financial Goals


Individuals experiencing financial well-being are also said to be on track to
meet their financial goals. They have a formal or informal financial plan
and actively work towards goals such as saving to buy a car or home,
paying off student loans, or setting aside funds for retirement.

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TOPIC 7 FINANCIAL HEALTH AND WELLNESS  151

(d) Having the Financial Freedom to Make Choices to Enjoy Life


Finally, individuals experiencing financial well-being are able to make
choices that allow them to enjoy life. They can splurge once in a while. They
can afford „wants‰ such as being able to go out to dinner or take a vacation,
meeting their „needs‰ and they are able to make choices such as to be
generous toward their friends, family and community.

How do we relate these four elements to the two common themes of financial
wellness? Well, let us look at Table 7.4 for the answer.

Table 7.4: Relationship between Common Themes and Elements of Financial Wellness

Theme Present Future


Security Control over your day-to-day, Capacity to absorb a
month-to-month finances financial shock

Freedom of choice Financial freedom to make choices On track to meet financial


to enjoy life goals

Source: Ratcliffe (2015)

Now, how do we balance this? Well, let us look at Figure 7.8 for an answer.

Figure 7.8: Live by a budget to achieve financial wellness

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152  TOPIC 7 FINANCIAL HEALTH AND WELLNESS

Here are some suggestions on what you should do specifically:

(a) Sign up for a retirement plan;


(b) Automate your savings;
(c) Establish a „freedom fund‰;
(d) Pay off your debts;
(e) Put your goals in writing;
(f) Track your own credit score (keep old credit card open; pay your bills on
time, every time; avoid full utilisation of credit card eligibility; and keep
below 30% of your available line of credit);
(g) Understand your taxes; and
(h) Manage your finances closely.

Table 7.5 gives you some dos and donÊts to improve your credit scores.

Table 7.5: Dos and DonÊts to Improve Your Credit Scores

Dos DonÊts

 Pay your bills on time.  Do not be afraid of credit. Using credit


wisely is important to becoming
 Keep your credit card balance low.
financially successful.
 Be patient.
 Avoid extravagance. Keep to the basic
as this will help you lay a stronger
overall financial foundation. Go for
luxury when you are more financially
secure.
 Do not let borrowings get you down.
Some critics question whether a study
loan is worth it. The answer is yes.
Research has shown that an education
loan will pay off over the course of your
career.
 Do not let jom jalan-jalan interfere with
your budget. Be sure to have a written
budget to help keep track of spending
and what you can afford to spend on.
 Be sensitive of your credit rating.

Source: PR Newswire (2015); DiGangi (2015)

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TOPIC 7 FINANCIAL HEALTH AND WELLNESS  153

SELF-CHECK 7.2

Explain what the elements of financial wellness are.

ACTIVITY 7.4

Share with your course mates whether you possess the elements of
financial wellness or not. Justify your answers.

7.4 FINANCIAL FITNESS


Before we end this topic as well as this module, let us look at financial fitness.
Hopefully by the end of this subtopic, you will be able to evaluate your financial
fitness. Let us begin by looking at the findings from PriceWaterhouseCoopers
(2015).

Over the years employers have learned that improving the health and
wellness of their workforce yields benefits for both employers and employees
alike. Employers enjoy a healthier workforce that is more productive, has
fewer absences and makes fewer demands upon employer-sponsored health
insurance. Employees benefit from improved health and well-being, and
reduced medical expenses.

From these statements, we can conclude that financial wellness programmes can
educate employees about the financial risks they face and provide tools to
manage those risks.

Therefore, workplace financial wellness must meet the following criteria in order
to be marketed as a financial wellness benefit (not to be confused with financial
education or financial advice) (Financial Finesse, 2014):

(a) Unbiased ă Free of sales pitches or conflict of interests;

(b) Designed and delivered by qualified experts who have extensive financial
planning experience;

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154  TOPIC 7 FINANCIAL HEALTH AND WELLNESS

(c) Delivered as an ongoing process ă Provide the support and accountability


that employees need to make, sustain and build upon positive financial
habit and behaviours;

(d) Holistic and comprehensive in nature ă Covers all aspect of financial


planning from debt management to more advanced estate planning;

(e) Personalised to the employee based on their specific needs;

(f) Integrate all employee benefits ă With guidance on how employees can
most effectively manage their benefits as part of their overall financial
plans; and

(g) Offered as a benefit available to all employees.

Last but not least, below are five elements you need to heed in your financial
budget (see Figure 7.9).

Figure 7.9: Five elements of financial budget

That marks the end of this topic. Hopefully, you have gained some insightful
knowledge on health and wellness, and is now able to come up with a plan to
stay healthy and well (physically and financially). Remember, health is wealth!

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TOPIC 7 FINANCIAL HEALTH AND WELLNESS  155

ACTIVITY 7.5

1. Evaluate your financial wellness by answering the questions


given. Award yourself 1 for Yes and 0 for No. Tally your score.
Then, ponder over your result with your friends.

(a) Do you pay yourself first? Set aside a certain amount for 
savings, retirement or investing before you do anything
else.

(b) Do you save at least 10% of your income? Meaning that 


at the end of each year, you must have set aside more
than one month of your salary for the future.

(c) Have you set aside an emergency fund to cover at least 


three monthsÊ worth of expenses? This is to soften the
blow if any unpredictable event occurred.

(d) Do you know the exact amount of your debt and the 
payables?

(e) Do you accelerate the payments of your debt? 


Remember, debts can snowball as a result of the
compounding process.

(f) Do you have financial goals? Short, medium as well as 


long-term goals?

(g) Do you have a record keeping system? 


(h) Do you live within a budget? 
(i) Do you know your net worth? 
2. Construct your budget for the current month. Make sure to list out
all the items in your financial health evaluation.

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156  TOPIC 7 FINANCIAL HEALTH AND WELLNESS

 Financial health is a term used to denote „the state of oneÊs personal financial
situation.‰ There are many dimensions of financial health such as disposable
income, savings and loan repayments.

 Financial fitness is just like physical fitness; one has to do things in certain
ways to be physically fit. Similarly, in order to be financially fit, one must
handle oneÊs finances in a proper balanced manner ă managing oneÊs
expenses, savings, debts and others in a befitting manner.

 The impact of a poor financial state can be compounded by widespread job


losses, declining asset values, great drops in value of savings. These adverse
phenomena can leave many in a state of financial distress.

 Financial distress is a term in corporate finance which describes a situation


where a company fails to honour its promises to pay its creditors according to
the agreed term of credit. If financial distress cannot be relieved, it may lead
to bankruptcy.

 Markers of adulthood refer to acquisition of social roles and responsibilities


that traditionally mark the process of becoming an adult. These markers
include the following:
ă Leaving home;
ă Entering the labour force market;
ă Marrying or becoming a parent for the first time; and
ă Assuming financial independence.

 Challenges confronting the emerging adults in their quest for financial


wellness can be categorised into economy challenges. Generation Y or
Millennials (born after 1980) face more economic challenges than Generation
X and Generation Y.

 Emerging adulthood is a phase in oneÊs life span between adolescence and


full-fledged adulthood which is considered to be developmental in nature. It
is a distinct period between 18 and 25 years of age wherein one struggles
with identity exploration, instability, self-focus and feeling in-between.

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TOPIC 7 FINANCIAL HEALTH AND WELLNESS  157

 There are four elements of financial wellness:


ă Having control over day-to-day, month-to-month finances;

ă Having the capacity to absorb a financial shock;

ă Being on track to meet financial goals; and

ă Having the financial freedom to make choices to enjoy life.

 Financial wellness programmes can educate employees about the financial


risks they face and provide tools to manage those risks. This can help them to
develop their financial fitness plan.

Adulthood Financial shock


Baby boomers Financial wellness
Emerging adulthood Generation X
Financial distress Generation Y
Financial fitness plan Make choices
Financial freedom Markers of adulthood
Financial goal Millennials
Financial health Pecking order
Financial independence

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158  TOPIC 7 FINANCIAL HEALTH AND WELLNESS

Alwi, S., Amir Hashim, I. Z., & Ali, M. S. (2015). Factors affecting savings habit
within millennials in Malaysia: Case study on students of TaylorÊs
University. Retrieved from
http://globalbizresearch.org/Malaysia_Conference/pdf/KL539.pdf

Arnett, J. J. (2000). Emerging adulthood: A theory of development from late teens


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being.pdf

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Drakopoulos, S. A., & Grimani, K. (2015). The effects of pay cuts on psychological
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Financial Finesse. (2014). Financial FinesseÊs official definition of financial wellness.


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of-needs-and-financial-enlightenment/

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20Adulthood%20English.pdf

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services/publications/assets/pwc-employee-financial-wellness-survey-
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credit-scores-of-all-generations-300121178.html

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160  TOPIC 7 FINANCIAL HEALTH AND WELLNESS

Ratcliffe, J. (2015). Four elements define personal financial well-being. Retrieved


from
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adolescence. New Directions for Youth Development, 111, 13ă28.

Copyright © Open University Malaysia (OUM)


Topic  Medical and
8 Health
Insurance
LEARNING OUTCOMES
By the end of this topic, you should be able to:
1. Explain the fundamentals of insurance;
2. Describe life insurance; and
3. Select appropriate medical and health insurance policies to suit the
needs of the insured.

 INTRODUCTION

Figure 8.1: Insurance


Source: http://www.apa.org/membership/insurance.aspx

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162  TOPIC 8 MEDICAL AND HEALTH INSURANCE

Do you really belief in life insurance? If your answer is yes, what is the ideal type
of insurance that will be beneficial to you and your family? Reflect on Figure 8.1
and describe in your own words what insurance is all about.

Some people believe that insurance can make help us feel more alive and
healthier by making healthcare less expensive, providing for our loved ones after
our death and allowing us to continue to receive an income even if we are unable
to work for months or years due to an illness or injury. In other words, the
motive of health insurance is to fund our healthcare-related expenses.

Topic 8 will give you some ideas on how insurance works and features the
common types of life insurance purchased by individuals and company with an
emphasis on medical and health insurance.

ACTIVITY 8.1

Research and choose the appropriate insurance that you think will
benefit you and your family. Discuss in the myINSPIRE forum.

8.1 WHAT IS INSURANCE?


Let us look at the definitions of insurance as quoted below:

„Insurance helps you to protect yourself against risks such as fire, car
accident or burglary. You can also get the type of insurance that pays you
money if you became too ill to work and to provide for your family or even
after you die‰.
The Money Advice Service (n.d.)

„An arrangement by which a company or the state undertakes to provide a


guarantee of compensation for specified losses, damages, illnesses or death
in return for payment of a specified premium‰.

Oxford Dictionaries (2017)

Copyright © Open University Malaysia (OUM)


TOPIC 8 MEDICAL AND HEALTH INSURANCE  163

Insurance is basically a contract between an individual (policyholder) and the


insurance company (insurer). This contract provides that the insurer will cover
several parts of the policyholderÊs losses as long as the policyholder meets certain
conditions which are stipulated in the insurance contract. The policyholder will
have to pay a premium for the insurance coverage (Pareto, n.d.). Thus, should
the policyholder incur a loss which is covered in the insurance such as car
accident or house on fire, the policyholder will have to file a claim for
reimbursement with the insurance company.

Before we proceed to the various aspects of life insurance, let us look at the basic
fundamentals of insurance.

8.2 FUNDAMENTALS OF INSURANCE


Imagine if you do not have any access to public transportation from where you
live and are unable to walk or ride a motorcyle to your destination, you will need
to drive a vehicle to work, carry out your daily tasks and have a social life.
However, driving will put you at risk of causing or getting involved in a car
accident.

You can, however, reduce the risks of driving by complying with the speed limit,
incorporating defensive driving, wearing your seat belts appropriately, not using
your handphone while driving and paying extra attention during challenging
driving situations such as traffic congestion or heavy rain. But no matter how
careful you are on the road, you can still get involved in an accident. For
example, you will be unable to predict that a rider would suddenly fall from his
motorcycle causing you to instinctly move to another lane and in the process you
hit someone at that lane. Insurance can help to protect you from such risks.
In this example, insurance allows you to transfer the majority of the financial
risks as a result of the accident to the insurance company in exchange for paying
a premium and sharing part of any losses through a deduction.

Each insurance policy offers different benefits. Different insurance companies


offer different scope of coverage. Some insurance companies offer comprehensive
policies which offer more coverage than just the basic insurance coverage.
Therefore, the choice is based on the preference of the policyholder.

Copyright © Open University Malaysia (OUM)


164  TOPIC 8 MEDICAL AND HEALTH INSURANCE

Let us take a look at the three main steps involved in the purchase of insurance
from identifying and selecting a policy to the process of making a claim from the
insurance company.

Firstly, you need to identify what type of protection that you would require.
The insurance company will calculate the risks of the event to be insured from
which the insurance provider will be able to determine the price that you, as the
policyholder, need to pay which is also known as your premium.

(a) Select a Policy


An insurance policy is a document that lists exactly what is or is not
covered. You need to compare the policy from different companies before
buying and then choose the policy that is most suitable for you. Take your
time to discuss with an insurance agent about the policy that you want to
purchase. Identify the most important aspect that you need by
understanding the terms and conditions of the policy as well as the scope of
coverage provided.

For example, a travel insurance policy might state that it will cover your
medical bills if you happen to injure yourself while travelling abroad but it
may not include the coverage if you were injured as a result of engaging in
some dangerous activities such as diving.

(b) Pay the Premium


Premium is the amount that the policyholder needs to pay on a monthly or
yearly basis in order to enjoy the insurance coverage. The amount depends
on the risks and the insured value of the event (The Money Advice Service,
n.d.).

For example, if you are an inexperienced driver, you are more likely to get
into an accident. As such, your car premium will be more expensive.
Moreover, the premium will be much higher if you drive an expensive car
because repairs tend to be more costly for this type of car.

(c) Make a Claim


If an accident or a mishap occurred and it is covered under the policy, the
policyholder can proceed to claim against the insurer. You, as a
policyholder, need to inform the insurance company what has happened
and provide valid evidences for them to check and process your claim.
If the claim falls under the covered event as stated and agreed in the policy,
the insurer will proceed to pay the agreed amount.

Copyright © Open University Malaysia (OUM)


TOPIC 8 MEDICAL AND HEALTH INSURANCE  165

ACTIVITY 8.2

In the myINSPIRE forum, discuss the different types of insurance which


are offered by various insurance companies and list the benefits of each
insurance policy.

8.3 LIFE INSURANCE


All too often we hear about the various types of life insurance policies without
understanding what they really are and more importantly, what they actually
protect or cover. There are six types of life insurance, namely term life, whole life,
endowment, investment-linked, medical and health, and mortgage reducing
term assurance (MRTA). In this topic, we will discuss medical and health
insurance in relation to the previous topics in this module.

Figure 8.2: Life Insurance


Source: https://www.google.com/search?q=Image+of+life+insurance&tbm

8.3.1 What is Life Insurance?


Life insurance is defined as a refuge against financial losses which results from
the death of the insured. The named recipient(s) in the policy will receive the
proceeds and is thus protected from financial consequences due to the death of
the insured. The death benefit is paid by the life insurer subject to premium
payments made by the insured party prior to his demise. The life insurance goal
is to provide a measure of financial security for the family in the event the
insured party dies. Therefore, before you purchase a life insurance policy,
consider your financial situation and the standard of living that you would want
to sustain for your dependent(s) or survivor(s).

Copyright © Open University Malaysia (OUM)


166  TOPIC 8 MEDICAL AND HEALTH INSURANCE

Questions to be considered, for example, would be: Who will be responsible for
the insuredÊs funeral costs and final medical bills? Will the family be forced to
move out of the current house? Are there enough funds for the future or ongoing
expenses such as childcare, mortgage and college payments? Therefore, it is
prudent to re-evaluate your life insurance policy annually or whenever you
experience major life events such as marriage, divorce, birth or child adoption, or
the purchase of key items such as a house or starting a business.

8.3.2 Types of Life Insurance Policies


If you are considering purchasing a life insurance policy, you need to understand
the types of life insurance available, how it works, how much does it cost and
which type is appropriate for you. Please refer to Figure 8.3 for the types of
insurance. For this module we will only focus on the medical and health
insurance.

Before we proceed further, it is also good to consider the following statement


when deciding on your insurance needs:

„Your employer may have already taken out a group plan whereby either your
employer pays the premiums or the employees pay the premiums on their own.
You should obtain the details or the terms of the policy as well as its coverage.
Even if you have a group plan, you should also look into getting an individual
plan because not only can you customise it to meet your needs but you would
also not have to worry about losing the insurance coverage in the event you
leave the job‰.

Insurance Info (2007)

Copyright © Open University Malaysia (OUM)


TOPIC 8 MEDICAL AND HEALTH INSURANCE  167

Figure 8.3: Types of life insurance

8.4 MEDICAL AND HEALTH INSURANCE


What do you understand by medical and health insurance?

Figure 8.4: Health insurance


Source: https://www.google.com/search?q=Image+of+life+insurance&tbm

Copyright © Open University Malaysia (OUM)


168  TOPIC 8 MEDICAL AND HEALTH INSURANCE

Health insurance is also referred to as medical and health insurance. Medical and
health insurance (MHI) is an insurance policy which is created to cover the costs
of private medical care which can be very costly especially with regard to
hospitalisation and surgery. MHI also ensures that policyholders do not have to
worry about the costs of seeking treatment during an emergency. In addition,
MHI also provides an income stream while the policyholder is undergoing
treatment.

You may obtain more information about MHI from the website
www.insuranceinfo.com.my.

8.4.1 Types of Medical and Health Insurance (MHI)


Policies
The following are the four main types of MHI policies:

(a) Hospitalisation and Surgical Insurance ă Provides hospitalisation and


surgical expenses due to illnesses covered under this policy;

(b) Critical Illness Insurance ă Provides benefits upon diagnosis of any of the
36 critical diseases listed;

(c) Disability Income Insurance ă Provides an income stream to replace part of


the insuredÊs income if work is not possible due to the illness or injury; and

(d) Hospital Income Insurance ă Pays a certain amount of money on a daily,


weekly or monthly basis (subject to annual limit) if the insured needs to be
hospitalised due to an illness or injury covered under the policy.

An insurance company may offer these products separately or in combination.


You need to be careful when choosing a policy. It is best to discuss with the
insurance company or its agent regarding the MHI policy that you are interested
to buy.

You should understand the scope of protection provided under the policy, the
various terms and conditions as well as the costs of the insurance coverage. You
also need to be aware of the possibilities and the effects if you wish to change
your policy from one insurance company to another or if you need to transfer
from one type of policy to another. For example, there may come a time when
you might be subjected to a different set of terms and conditions of a new policy
or a new insurance company.

Copyright © Open University Malaysia (OUM)


TOPIC 8 MEDICAL AND HEALTH INSURANCE  169

As mentioned, insurance companies offer MHI policies either separately or in


combination. In order to meet your needs, there are several important
considerations when you shop for a MHI policy such as:

(a) You need to calculate and determine whether you can afford the premium
of the selected MHI cover. Do not buy more than what you can afford;

(b) Retain the agent and the insurance companyÊs information, for example, the
business card with the agentÊs name, companyÊs name, address and
telephone number. This will be very useful when you want to enquire,
renew or make a claim against the policy later on;

(c) Understand the terms and conditions of the policy as well as the scope of
coverage provided; and

(d) Read your policy contract very carefully.

SELF-CHECK 8.1

Explain the important considerations when shopping for an MHI policy.

8.4.2 MHI Policy Benefits


The benefit payment depends on the type of policy purchased. Policyholders
must review the policy contract for details about the benefits, what benefits are
and/or are not covered as well as when and how the benefits will be paid.

To consider which MHI policy to choose, let us look at the following options:

(a) A Group Plan (at Work)


This plan is when the employer pays the premiums or when employees pay
the premiums on their own. If it is a group plan sold under a scheme,
the individuals should get the details of the terms of the policy between the
organiser of the scheme and the insurance company particularly regarding
the terms and conditions of the schemeÊs continuity aspect. It is also
important to ensure that the insurance coverage offered under the scheme
is provided by a licensed insurance company.

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170  TOPIC 8 MEDICAL AND HEALTH INSURANCE

(b) An Individual Plan


Individual insurance generally costs more than group insurance. However,
the policyholder may be able to customise his MHI policy to meet his needs
according to his financial capability.

8.4.3 Policy Renewal


The insurance company will usually explain the renewal policy to the
policyholders when it is time to renew their policies. The options for renewal are:

(a) Renew the policy with a premium level;

(b) Renew the policy with premium enhancements; or

(c) Refuse to renew the policy.

8.4.4 Policy Cancellation


MHI policy can be cancelled by giving a written notice to the insurance company.
The policyholder might be entitled to a refund on certain premiums or for certain
types of MHI policies provided if the policyholder has not made any claims on
the policy thus far. Policyholders will be able to get the details of the cancellation
process from the terms stated in the policy contract or from the insurance
company or its agents.

8.4.5 Exceptions
The MHI policy also contains certain exceptions. The policyholder should be
aware of what these exceptions are and if he does not understand them,
he should ask his agent or the insurance company for further explanation.

Some common exceptions are as follows:

(a) Existing Situation


This refers to the conditions and illnesses that the policyholder experienced
before applying for the policy. These conditions and illnesses will be
exempt from protection by the insurance company. The policyholder
should check with his insurance company about the details of the existing
conditions for the policy that he wishes to purchase.

Copyright © Open University Malaysia (OUM)


TOPIC 8 MEDICAL AND HEALTH INSURANCE  171

(b) Defined Illnesses


This is defined as the 12 illnesses (for example, tumour and gastritis) and its
related circumstances. The policyholder will not be protected for these
illnesses if any of the illnesses has been treated or happened within the first
12 months of his policy.

(c) Eligibility or Waiting Period


Policyholders are not eligible for any claims arising from any medical or
physical conditions within the first 30 days of protection except for
unintentional injuries.

8.4.6 Making a Claim


Making a claim can be more convenient if the policyholder knows what to do
and what his responsibilities are. Some important points relating to claims are as
follows:

(a) PolicyholderÊs Responsibility

(i) The policyholder should call the insurance company to check whether
the treatment is covered or if the hospital is the insurance companyÊs
panel hospital before he receives any treatment. In fact, some
insurance companies insist that their policyholders do this prior to
seeking treatment;

(ii) The claim forms will probably need to be completed and signed by
the doctors or specialists and they may charge a small fee which will
not be covered by the insurance company;

(iii) The policyholder must keep in touch with his insurance company
regarding the status of his claim;

(iv) The policyholder may be recommended for a test or admission to the


hospital as an inpatient by the specialist; and

(v) Most insurance companies will pay the bills directly to the hospital as
well as to some specialists. Others will send the bills to the
policyholders first instead.

Copyright © Open University Malaysia (OUM)


172  TOPIC 8 MEDICAL AND HEALTH INSURANCE

(b) Insurance CompanyÊs Responsibility

(i) The insurance company will provide the policyholder with all the
guidance needed, confirm the expenses covered and, if necessary,
send the claim form to the policyholder; and

(ii) The insurance company will inform the policyholder how it will make
the payment for the claim.

 Insurance is perceived as being able to help us stay more alive and healthier
by making healthcare less expensive when we need it, providing financial
help for our loved ones after our death and allowing us to continue to have
an income even if we are not able to work for months or years as a result of
an illness or injury.

 The amount of life insurance that you need depends on how much money
you need to support your lifestyle and to pay for your expenses when you are
critically ill or disabled as a result of an illness or accident.

 When making a claim, ensure that all the documents needed by the insurance
company are supplied to them in order to speed up the claim process.

Cancellation Insurance coverage


Claim Insurance premium
Exceptions Life insurance
Health insurance Renewal

Copyright © Open University Malaysia (OUM)


TOPIC 8 MEDICAL AND HEALTH INSURANCE  173

Astor, B. (2013). All about health insurance. In B. Astor, Roadmap for the rest of
your life: Smart choices about money, health, work, lifestyle ... and
pursuing your dreams (pp. 51ă70). Hoboken, NJ: John Wiley & Sons, Inc.

Insurance Info. (2007). Medical & health insurance. Retrieved from


http://www.insuranceinfo.com.my/choose_your_cover/insure_your_
health/medical_health_insurance.php?intPrefLangID=1&

Insurance. (2017). In Oxford dictionaries (online). Retrieved from


https://en.oxforddictionaries.com/definition/insurance

Pareto, C. (n.d.). Intro to insurance: What is insurance? Retrieved from


https://www.investopedia.com/university/insurance/insurance1.asp

The Money Advice Service (n.d.). What is insurance? Retrieved from


https://www.moneyadviceservice.org.uk/en/articles/what-is-insurance

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MAKLUM BALAS MODUL

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1. E-mail your comment or feedback to modulefeedback@oum.edu.my

OR

2. Fill in the Print Module online evaluation form available on myINSPIRE.

Thank you.

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